Evolution of Invasive Therapies in Acute Myocardial Infarction: A Descriptive Review

Abstract

Acute myocardial infarction (AMI) is a major cardiovascular emergency in which rapid restoration of coronary blood flow is essential to minimize myocardial damage and improve patient outcomes. The management of AMI has undergone substantial evolution, progressing from conventional surgical revascularization to less invasive percutaneous coronary interventions (PCI). Coronary artery bypass grafting (CABG), although an established and effective revascularization procedure, involves open-chest surgery and is associated with greater procedural invasiveness, longer recovery, and increased perioperative burden compared with contemporary catheter-based interventions. The introduction of balloon angioplasty represented an important advancement by allowing coronary revascularization without open surgery; however, balloon angioplasty alone was limited by complications such as elastic recoil, vessel dissection, and restenosis, which reduced its longterm effectiveness. The development of intracoronary stents subsequently transformed PCI by providing mechanical support to the treated vessel, reducing acute vessel closure and improving procedural success and long-term vessel patency. In the contemporary management of AMI, particularly ST-segment elevation myocardial infarction (STEMI), primary PCI with stent implantation is widely preferred when it can be performed promptly by an experienced team. Its minimally invasive nature, high procedural success, and ability to rapidly restore coronary perfusion have established stenting as a major advancement in invasive AMI treatment. This descriptive review traces the evolution from CABG and balloon angioplasty to modern stentbased PCI and discusses the clinical advantages, limitations, and continuing developments in invasive revascularization strategies for AMI.