MYOCARDIAL REVASCULARIZATION: EVALUATION OF THE CLINICAL APPROACH AND INDICATIONS IN PATIENTS WITH AMI

Abstract

Acute myocardial infarction (AMI) remains one of the leading causes of cardiovascular morbidity and mortality worldwide. Myocardial revascularization, either by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), represents a crucial therapeutic strategy to restore coronary blood flow and minimize myocardial damage in patients with AMI. The choice of the optimal revascularization approach depends on several factors, including the severity of AMI, the presence of comorbidities, coronary anatomy, and the availability of resources. Objective: This systematic literature review aims to critically analyze the available scientific evidence on the evaluation of the clinical approach and indications for myocardial revascularization in patients with AMI. The objective is to provide a comprehensive synthesis of best clinical practices, identify knowledge gaps, and guide decision-making in clinical practice. Methodology: A systematic search was performed in the PubMed, SciELO and Web of Science databases, using the descriptors "myocardial infarction", "myocardial revascularization", "percutaneous coronary intervention", "myocardial revascularization surgery" and "clinical evaluation". The search included articles published in the last 10 years, in Portuguese and English. The inclusion criteria were: studies that addressed the evaluation of the clinical approach and the indications for myocardial revascularization in patients with AMI. The exclusion criteria were: studies that did not meet the inclusion criteria, such as isolated case reports, animal studies or studies that did not address myocardial revascularization. Results: The review identified 15 studies that reinforced the use of PCI and CABG in myocardial revascularization in patients with AMI. PCI, when performed early, has been shown to be effective in restoring coronary blood flow and reducing myocardial damage in patients with ST-segment elevation myocardial infarction (STEMI). CABG, in turn, is generally reserved for patients with complicated STEMI, multivessel disease, or coronary anatomy unfavorable for PCI. Careful clinical evaluation, risk stratification, and coronary angiography are crucial to guide the choice of the optimal revascularization approach. Conclusion: Myocardial revascularization, whether by PCI or CABG, represents a fundamental therapeutic strategy in the management of patients with AMI. The choice of the optimal approach should be individualized, taking into account the clinical and angiographic characteristics of each patient. Careful clinical evaluation, risk stratification, and coronary angiography are essential to optimize clinical outcomes and improve the prognosis of these patients.