Background <p>The severe acute respiratory syndrome coronavirus&#xa0;2 (SARS-CoV-2) pandemic led to a&#xa0;significant decrease in inpatient cases in German hospitals. This study analyzes the development in case numbers for myocardial infarctions and cerebrovascular events at a&#xa0;maximum care provider compared to regional and national trends.</p> Methods <p>In this retrospective cohort study, based on routine data from the University Hospital Leipzig (UKL) for the period 2019–2023, case number developments for myocardial infarctions and selected cerebrovascular emergencies were examined and compared to trends based on state and federal data from 2019–2022. Additionally, an analysis of demographic data was performed in year-to-year comparisons.</p> Results <p>At UKL there was an overall decrease in case numbers of 8.4% between 2019 and 2022 and of 4.7% between 2019 and 2023. This is below the case number decrease for Saxony (12.9%) and Germany (11.4%). For myocardial infarctions (<i>n</i> = 2263), there was a&#xa0;decrease of 11.4% between 2019 and 2023. During this period, Saxony recorded a&#xa0;decrease of 14.3% and Germany of 10.3%. For acute cerebrovascular events (<i>n</i> = 6287) the gradual decrease over the period 2019–2023 was 7.5%. Patient age showed no significant changes over the observation period after post hoc testing (71.1 ± 14.1&#xa0;years; <i>p</i> &gt; 0.05). The length of stay varied slightly during the observation period (9.9 ± 9.4&#xa0;days). The patient clinical complexity level (PCCL) was 1.5 ± 1.6 during the observation period.</p> Conclusion <p>This study provides evidence that maximum care providers show a&#xa0;smaller decrease in case numbers compared to regional and national trends for myocardial infarctions and acute cerebrovascular diseases. The results underline the importance of maximum care structures in the acute treatment of complex diseases. When planning capacities within the healthcare landscape, consideration of such observations appears necessary.</p>