COVID-19 is a global pandemic that spread rapidly around the world. It led to changes in management plans for different diseases due to the occupation of the health services and staff with the COVID battel, in addition to lockdown consequences. Cardiac emergency management, such as ST-segment elevation myocardial infarction, was affected at multiple levels by the COVID-19 pandemic, including a delay in patients' threshold to call emergency medical services, decreased availability of ambulances, increased waiting time in the emergency departments, and time delay in percutaneous coronary intervention due to the time consumed for personal protective measures. ESC released a guide based on the experiences of healthcare workers to help in decision-making in different cases. The guide recommended various diagnostic modalities to detect vulnerable patients, but all these modalities have different limitations. Egypt, Saudi Arabia, United Arab Emirates, Yamen, Bahrain, Kuwait, and Tunisia are different Arab countries with different populations and political and economic conditions. They responded to the global pandemic according to their different conditions guided by the global cumulative experiences.