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

Previous studies highlight the impact of conflict and war on cardiovascular health, suggesting increased incidence of events like STEMI due to heightened stress and healthcare disruptions. However, specific data on STEMI management and outcomes during active conflicts remain limited. This study assesses the impact of the October 2023 war in Israel on STEMI incidence, late arrivals, and the potential correlation with the intensity of rocket fire.

This retrospective cohort study was conducted at Soroka University Medical Center, Beer Sheva, Israel, from 2021 to 2023. Data from patients admitted with STEMI during a two-month period (October 7 to December 7) across these years were analyzed. Patient demographics, arrival characteristics, clinical and PCI characteristics, and outcomes were compared across pre-war (2021-2022) and war (2023) periods. Multivariable logistic regression identified predictors of late arrivals, and Spearman correlation assessed the relationship between rocket attacks and STEMI cases and late arrivals.

The study included 193 STEMI patients (83.4% male, average age 62.87 years). A significant increase in late arrivals was observed during the war period (28.8% in 2023 vs. 10.2% pre-war, p = 0.002). Ambulance arrivals decreased (34.8% in 2023 vs. 59.1% pre-war), while referrals from emergency centers increased (57.6% in 2023 vs. 25.2% pre-war, p < 0.001). Clinical characteristics and PCI outcomes including time metrics such as door-to-balloon (D2B) and pain-to-balloon (P2B), showed no significant differences between the periods. The period of war was a significant predictor of late arrivals (AdjOR 3.12, 95% CI 1.29-7.85, p = 0.013). Correlation analysis between rocket attacks and STEMI cases was not statistically significant.

While hospital care remained robust, there was a marked increase in late arrivals and patients coming from emergency centers, indicating delays in seeking medical attention and fear of going directly to the hospital. These findings highlight the need for targeted patient education to ensure prompt care during conflicts and improve confidence in hospital safety and availability.