STEMI under fire: evaluating management and challenges in a warzone amidst the 2023 Israeli conflict

Area of Science:

• Cardiology
• Public Health
• Emergency Medicine

Background:

• Conflict and war are known to negatively impact cardiovascular health, increasing risks like ST-elevation myocardial infarction (STEMI).
• Limited data exist on STEMI management and outcomes specifically during active conflict periods.
• This study investigates the impact of the October 2023 war in Israel on STEMI incidence and patient arrival times.

Purpose of the Study:

• To assess the impact of the October 2023 war on STEMI incidence in Israel.
• To evaluate changes in STEMI patient arrival characteristics, specifically late arrivals and mode of transport.
• To explore the correlation between rocket fire intensity and STEMI cases or late arrivals.

Main Methods:

• Retrospective cohort study at Soroka University Medical Center, Israel (2021-2023).
• Analysis of STEMI patients admitted during a two-month period (Oct 7 - Dec 7) across pre-war and war years.
• Comparison of demographics, clinical data, PCI outcomes, and arrival characteristics using logistic regression and Spearman correlation.

Main Results:

• A significant increase in late STEMI arrivals was observed during the war period (28.8% vs. 10.2%, p=0.002).
• Ambulance arrivals decreased, while emergency center referrals increased significantly during the war (p<0.001).
• War period was a predictor of late arrivals (AdjOR 3.12); no significant correlation found between rocket attacks and STEMI cases.

Conclusions:

• Hospital care for STEMI remained effective, with no significant differences in door-to-balloon or pain-to-balloon times.
• Increased late arrivals and emergency center referrals suggest patient apprehension and delays in seeking direct hospital care during conflict.
• Targeted patient education is vital to ensure prompt STEMI treatment and build confidence in hospital safety during wartime.