Zeldetz Vladimir, Shashar Sagi, Cafri Carlos, Shamia David, Slutsky Tzachi, Regev Noa Fried, Abed Naif Abu, Schwarzfuchs Dan
Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel.
Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva, 84101, Israel.
BMC Health Serv Res. 2025 May 8;25(1):661. doi: 10.1186/s12913-025-12809-3.
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.
先前的研究强调了冲突和战争对心血管健康的影响，表明由于压力增加和医疗服务中断，ST段抬高型心肌梗死（STEMI）等事件的发生率上升。然而，关于冲突期间STEMI管理和结局的具体数据仍然有限。本研究评估了2023年10月以色列战争对STEMI发病率、延迟就诊情况以及与火箭弹袭击强度潜在相关性的影响。
这项回顾性队列研究于2021年至2023年在以色列贝尔谢巴的索罗卡大学医学中心进行。分析了这些年份中两个月期间（10月7日至12月7日）因STEMI入院患者的数据。比较了战前（2021 - 2022年）和战争期间（2023年）患者的人口统计学特征、就诊特征、临床和经皮冠状动脉介入治疗（PCI）特征以及结局。多变量逻辑回归确定延迟就诊的预测因素，Spearman相关性分析评估火箭弹袭击与STEMI病例及延迟就诊之间的关系。
该研究纳入了193例STEMI患者（男性占83.4%，平均年龄62.87岁）。在战争期间观察到延迟就诊显著增加（2023年为28.8%，战前为10.2%，p = 0.002）。救护车送诊人数减少（2023年为34.8%，战前为59.1%），而来自急救中心的转诊人数增加（2023年为57.6%，战前为25.2%，p < 0.001）。各时期的临床特征和PCI结局，包括门球时间（D2B）和疼球时间（P2B）等时间指标，均无显著差异。战争时期是延迟就诊的显著预测因素（调整后比值比3.12，95%置信区间1.29 - 7.85，p = 0.013）。火箭弹袭击与STEMI病例之间的相关性分析无统计学意义。
虽然医院医疗服务保持稳健，但延迟就诊和来自急救中心的患者显著增加，这表明寻求医疗救治存在延迟以及对直接前往医院存在恐惧。这些发现凸显了有针对性地开展患者教育的必要性，以确保在冲突期间能及时获得治疗，并提高对医院安全性和可及性的信心。
