INTRODUCTION: Earthquakes are unpredictable natural events that can elicit acute physiological responses, potentially triggering cardiovascular events. This study investigates the association between seismic activity and ST-elevation myocardial infarction (STEMI) admissions in a tertiary care hospital in an earthquake-prone region over 19 years. METHODS: We analyzed STEMI admissions at a tertiary center in Mexico City from October 2005 to August 2024. Earthquakes with a magnitude ≥6.0 and geographic relevance to Mexico were identified using the USGS database. Admission rates were compared for ±7 days surrounding each earthquake and control periods derived from the same date in the previous year, adjusted for overlaps and seismic events. Poisson regression analyses were used to compare admission rates. RESULTS: Among 9611 STEMI patients, 904 admissions occurred near earthquake periods, with 863 during controls. Post-earthquake admissions rose significantly on the day earthquake (day 0) with an incidence rate ratio (IRR) = 1.49 (95 % CI 1.17-1.89, P = 0.001), and in the post-quake (+1 to +7 days) IRR = 1.19 (95 % CI 1.03-1.36, P = 0.015) compared to the pre-quake (-7 to -1 days) period. Notably, admissions on days +1 and + 2 (IRR = 1.54 [95 % CI 1.11-2.14] and 1.58 [95 % CI 1.07-2.34]) showed a significant increase compared to controls. Elevated systolic blood pressure was observed post-quake, while demographics, severity, and mortality showed no significant differences. CONCLUSIONS: Our findings suggest a significant association between earthquake events and increased STEMI admissions within the days following an earthquake in a high-seismic area. Compared to pre-earthquake and control periods, the observed rise in post-earthquake admissions indicates that seismic stress may contribute to STEMI events.