Abstract
BACKGROUND: Thrombolytic therapy is indicated for patients with ST-segment elevation myocardial infarction (STEMI) presenting >120 minutes from a percutaneous coronary intervention-capable facility. Timely transfer is critical in thrombolytic failure. CASE SUMMARY: A 46-year-old woman presented to a rural emergency department with an anterior STEMI. Thrombolytics failed. Transfer was delayed because of a snowstorm. She arrived at our facility hours later in cardiogenic shock. She was treated with rescue percutaneous coronary intervention and initiation of mechanical circulatory support with a percutaneous transvalvular microaxial flow pump. She ultimately recovered and has done well on follow-up. DISCUSSION: The patient presented to the emergency department promptly and was appropriately treated in a timely manner. However, geographic isolation and inclement weather posed insurmountable and potentially life-threatening delays in care. TAKE-HOME MESSAGES: Rural-urban health disparities can complicate the STEMI pathway. Prompt recognition and treatment of thrombolytic failure and cardiogenic shock is critical to patient outcomes.