The Irreversible March of Time: Ischemic Delay and Impact on Outcomes in ST-Segment Elevation Myocardial Infarction
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| Publicado en: | Journal of Cardiovascular Development and Disease vol. 12, no. 12 (2025), p. 474-499 |
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| Autor principal: | |
| Otros Autores: | , , , |
| Publicado: |
MDPI AG
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| Acceso en línea: | Citation/Abstract Full Text + Graphics Full Text - PDF |
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| 045 | 2 | |b d20250101 |b d20251231 | |
| 100 | 1 | |a Dziewierz Artur |u 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; artur.dziewierz@uj.edu.pl (A.D.); barbarazdzierak@gmail.com (B.Z.) | |
| 245 | 1 | |a The Irreversible March of Time: Ischemic Delay and Impact on Outcomes in ST-Segment Elevation Myocardial Infarction | |
| 260 | |b MDPI AG |c 2025 | ||
| 513 | |a Journal Article | ||
| 520 | 3 | |a ST-segment elevation myocardial infarction (STEMI) represents a time-critical medical emergency where complete coronary artery occlusion initiates progressive myocardial necrosis. The fundamental principle of modern STEMI care—“Time is Muscle”—establishes that ischemic duration directly determines infarct size and clinical outcomes. Each minute of delay correlates with increased mortality, larger infarcts, and a higher risk of heart failure development. Total ischemic time encompasses both patient-mediated delays (often the largest component) and system-related delays, each influenced by distinct factors requiring targeted interventions. This comprehensive review analyzes the components of total ischemic time, quantifies the clinical consequences of delay, and evaluates evidence-based mitigation strategies. We examine the evolution from fibrinolysis to primary percutaneous coronary intervention and the resulting logistical challenges. System-level interventions—including public awareness campaigns, regionalized STEMI networks, pre-hospital ECG acquisition, and standardized hospital protocols—have dramatically reduced treatment times. However, persistent disparities based on geography, presentation timing, sex, race, and age remain problematic. Emerging technologies, particularly artificial intelligence for ECG interpretation, offer promise for further time reduction. | |
| 653 | |a Patients | ||
| 653 | |a Acute coronary syndromes | ||
| 653 | |a Veins & arteries | ||
| 653 | |a Ischemia | ||
| 653 | |a Heart attacks | ||
| 653 | |a Mortality | ||
| 653 | |a Hospital systems | ||
| 700 | 1 | |a Zdzierak, Barbara |u 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; artur.dziewierz@uj.edu.pl (A.D.); barbarazdzierak@gmail.com (B.Z.) | |
| 700 | 1 | |a Wańha Wojciech |u Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-635 Katowice, Poland; wojciech.wanha@gmail.com | |
| 700 | 1 | |a Luca Giuseppe De |u Division of Cardiology, AOU Policlinico G Martino, University of Messina, 98124 Messina, Italy; giuseppe.deluca@uniume.it | |
| 700 | 1 | |a Rakowski Tomasz |u 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 30-688 Krakow, Poland; artur.dziewierz@uj.edu.pl (A.D.); barbarazdzierak@gmail.com (B.Z.) | |
| 773 | 0 | |t Journal of Cardiovascular Development and Disease |g vol. 12, no. 12 (2025), p. 474-499 | |
| 786 | 0 | |d ProQuest |t Health & Medical Collection | |
| 856 | 4 | 1 | |3 Citation/Abstract |u https://www.proquest.com/docview/3286307501/abstract/embedded/7BTGNMKEMPT1V9Z2?source=fedsrch |
| 856 | 4 | 0 | |3 Full Text + Graphics |u https://www.proquest.com/docview/3286307501/fulltextwithgraphics/embedded/7BTGNMKEMPT1V9Z2?source=fedsrch |
| 856 | 4 | 0 | |3 Full Text - PDF |u https://www.proquest.com/docview/3286307501/fulltextPDF/embedded/7BTGNMKEMPT1V9Z2?source=fedsrch |