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Zahrai et al. Vessel Plus 2023;7:32 Vessel Plus
DOI: 10.20517/2574-1209.2023.100

Review Open Access

Optimal timing of surgical revascularization in

patients with acute myocardial infarction

1,2
1
Amin Zahrai , Kenza Rahmouni , Fraser D. Rubens 1,2
1
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
2
Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
Correspondence to: Prof. Fraser D. Rubens, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin St,
Ottawa, ON K1Y 4W7, Canada. E-mail: frubens@ottawaheart.ca
How to cite this article: Zahrai A, Rahmouni K, Rubens FD. Optimal timing of surgical revascularization in patients with acute
myocardial infarction. Vessel Plus 2023;7:32. https://dx.doi.org/10.20517/2574-1209.2023.100

Received: 3 Aug 2023 First Decision: 15 Nov 2023 Revised: 7 Dec 2023 Accepted: 12 Dec 2023 Published: 18 Dec 2023

Academic Editor: Manel Sabaté Copy Editor: Fangyuan Liu Production Editor: Fangyuan Liu

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.

Keywords: Acute myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention,
surgical timing optimization

INTRODUCTION
Acute myocardial infarction (AMI) is among the leading causes of mortality in developed nations, with a
[1,2]
prevalence of 3.8% in those younger than 60 years and 9.5% in those older than 60 years . Preferred
treatment options for AMI have evolved in the past 50 years, toggling between pharmacotherapeutic,

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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