Optimal timing of surgical revascularization in patients with acute myocardial infarction

Abstract

Acute myocardial infarction (AMI) is the leading cause of cardiovascular mortality in developed countries. While primary percutaneous coronary intervention is the gold-standard first-line therapy for initial revascularization of a culprit vessel, coronary artery bypass grafting (CABG) surgery can allow for subsequent complete revascularization when additional high-risk coronary stenoses remain. The optimal timing of CABG after AMI remains controversial. Early surgery during the acute period can lead to a detrimental systemic inflammatory response and may be associated with a higher bleeding risk due to the use of antiplatelet and fibrinolytic agents. On the other hand, later surgery increases the risk of ischemic recurrence while waiting, with the potential for an irreversible decrease in myocardial function or death. This narrative review summarizes the evidence supporting decision-making for optimal timing of surgical revascularization in patients with AMI.