Surgical treatment of acute myocardial infarct: clinical considerations.

Most clinicians have become convinced of the fundamental role of an early reperfusion strategy in the improved outcome for patients suffering acute myocardial infarction. An increasing body of work suggests that the surgeon has the best opportunity for control of the conditions of acute reperfusion, attenuation of secondary injury, and provision of superior myocardial salvage compared with thrombolytic or angioplasty therapy. Before general acceptance or implementation of surgical treatment as an initial treatment for certain acute infarct patient subgroups, the policy must be compared with our current standards of care in a prospective, randomized fashion. The available data suggest that such inclusion of a primary surgical option in trials investigating treatment of acute myocardial infarct is long overdue.