Surgical revascularization in acute myocardial infarction Back to the future?

Acute myocardial infarction (AMI) and ischemic heart disease still belong to the most common causes of death worldwide. The ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) differ not only by a different pathogenesis of myocardial ischemia but patients with STEMI also exhibit different characteristics and survival rates compared to those with NSTEMI. Therefore, these groups have to be managed differently. This includes the urgency with which reperfusion therapy should be carried out. At the end of the 1960s revascularization procedures were performed in AMI for the first time. These were achieved surgically as a cooperation between the cardiologist Sones and the heart surgeon Favaloro. Although several studies in the following years proved the success of the concept of acute surgical revascularization, this approach was not pursued further as soon as medicinal thrombolysis was introduced as a treatment of patients with AMI. This article summarizes the historical development of AMI management as well as current treatment strategies. Furthermore, the potential advantages and disadvantages of direct operative revascularization in the setting of AMI are discussed.