Did a 2.25-hour delay worsen heart damage after STEMI?

Question

Hello doctor,

I have HFrEF with an ejection fraction of 30 percent and 59 percent scarring of my left ventricle. I experienced a STEMI that was not identified for 20 hours, and after arriving at the hospital.

I encountered an additional two hour 25 minutes delay before reaching the catheterization laboratory. How much of my resulting heart failure and ventricular scarring could be attributed to that two-hour 25-minute delay?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

It is impossible to determine exactly how much of the heart failure and 59 percent left ventricular scarring was caused by the additional two hour 25 minutes delay.

However, in a STEMI (ST-segment elevation myocardial infarction), the greatest amount of irreversible heart muscle damage typically occurs during the first several hours of blocked blood flow. Since the infarction was not recognized for approximately 20 hours, a substantial amount of the damage had likely already occurred before arrival at the hospital.

That said, every hour of ongoing ischemia can contribute to additional muscle loss, a larger scar size, and worse long-term heart function. Thus, while the additional 2.25 hours of delay may have increased the amount of injury, it is unlikely to alone account for the severe scarring and reduced ejection fraction.

To better assess the impact of delay, a thorough review of the coronary anatomy, infarct location, collateral circulation, and cardiac magnetic resonance imaging (MRI) findings would be needed.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.