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Review
. 2024 Sep 15;13(18):5484.
doi: 10.3390/jcm13185484.

Management of Myocardial Infarction and the Role of Cardiothoracic Surgery

Shannon Parness  1 , Panagiotis Tasoudis  1 , Chris B Agala  2 , Aurelie E Merlo  1
Affiliations
Review

Management of Myocardial Infarction and the Role of Cardiothoracic Surgery

Shannon Parness et al. J Clin Med. .

Abstract

Myocardial infarction (MI) is a leading cause of mortality globally and is predominantly attributed to coronary artery disease (CAD). MI is categorized as ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI), each with distinct etiologies and treatment pathways. The goal in treatment for both is restoring blood flow back to the myocardium. STEMI, characterized by complete occlusion of a coronary artery, is managed urgently with reperfusion therapy, typically percutaneous coronary intervention (PCI). In contrast, NSTEMI involves a partial occlusion of a coronary artery and is treated with medical management, PCI, or coronary artery bypass grafting (CABG) depending on risk scores and clinical judgment. The Heart Team approach can assist in deciding which reperfusion technique would provide the greatest benefit to the patient and is especially useful in complicated cases. Despite advances in treatment, complications such as cardiogenic shock (CS) and ischemic heart failure (HF) remain significant. While percutaneous coronary intervention (PCI) is considered the primary treatment for MI, it is important to recognize the significance of cardiac surgery in treatment, especially when there is complex disease or MI-related complications. This comprehensive review analyzes the role of cardiac surgery in MI management, recognizing when it is useful, or not.

Keywords: CABG; PCI; cardiac surgery; myocardial infarction; post-MI complications.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Adaptation of the 2021 ACC/AHA Indications for Revascularization in NSTEMI. Acronyms: ACC: American College of Cardiology, AHA: American Heart Association, NSTEMI: Non-ST-Elevation Myocardial Infarction, CABG: coronary artery bypass graft, PCI: percutaneous coronary intervention.
Figure 2
Figure 2
Adaptation of the 2021 ACC/AHA Indications for Revascularization in STEMI. Acronyms: ACC: American College of Cardiology, AHA: American Heart Association, STEMI: ST-Elevation Myocardial Infarction, CABG: coronary artery bypass graft, PCI: percutaneous coronary intervention, CS: cardiogenic shock, HF: heart failure.
See this image and copyright information in PMC

References

    1. Thygesen K., Alpert J.S., White H.D. Universal Definition of Myocardial Infarction. J. Am. Coll. Cardiol. 2007;50:2173–2195. doi: 10.1016/j.jacc.2007.09.011. - DOI - PubMed
    1. Benjamin E.J., Blaha M.J., Chiuve S.E., Cushman M., Das S.R., Deo R., de Ferranti S.D., Floyd J., Fornage M., Gillespie C., et al. Heart disease and stroke statistics—2017 update: A report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485. - DOI - PMC - PubMed
    1. Harrington D.H., Stueben F., Lenahan C.M. ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction: Medical and Surgical Interventions. Crit. Care Nurs. Clin. N. Am. 2019;31:49–64. doi: 10.1016/j.cnc.2018.10.002. - DOI - PubMed
    1. Reynolds K., Go A.S., Leong T.K., Boudreau D.M., Cassidy-Bushrow A.E., Fortmann S.P., Goldberg R.J., Gurwitz J.H., Magid D.J., Margolis K.L., et al. Trends in Incidence of Hospitalized Acute Myocardial Infarction in the Cardiovascular Research Network (CVRN) Am. J. Med. 2017;130:317–327. doi: 10.1016/j.amjmed.2016.09.014. - DOI - PMC - PubMed
    1. Gheorghiade M., Bonow R.O. Chronic heart failure in the United States. Circulation. 1998;97:282–289. doi: 10.1161/01.CIR.97.3.282. - DOI - PubMed

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