Surgery as early revascularization after acute myocardial infarction

Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality in most industrialized nations throughout the world. Options for myocardial revascularization include thrombolysis or percutaneous coronary intervention (PCI) in the early period after AMI, or coronary artery bypass grafting (CABG) for suitable patients. It has commonly been suggested that surgery in the early period after AMI can be associated with increased morbidity and mortality. However, advances in technology, surgical methods and myocardial protection techniques currently provide a chance for cardiovascular surgeon to achieve CABG in the setting of AMI. In patients with AMI, interest in early surgical revascularization has decreased with widespread use of thrombolytics or PCI. However, early surgical revascularization is beneficial in patients who have mechanical complications, ongoing ischemia, and cardiogenic shock complicating AMI. Failure of thrombolytic agents, unsuccessful PCI or left main coronary artery disease also requires surgery. Theoretically, early surgical revascularization may be useful by minimizing infarct size improving left ventricular function, and increasing patient survival. The optimal timing of surgery after AMI remains undecided as a controversial subject. It ranges from immediate surgical intervention to surgery 30 days after myocardial infarction. Therefore, such a wide variation in the therapeutic strategy of the surgical groups has made way a selection bias in these patients. This review presented highlights optimal timing of surgical revascularization after AMI, surgical methods and controlled reperfusion, risk factors for poor outcomes after surgery for AMI, and the role of surgery in patients with AMI complicated by cardiogenic shock.