Personalizing myocardial revascularization strategies in the setting of acute myocardial infarction.

INTRODUCTION: Revascularization post myocardial infarction is a complex interplay of patient and anatomical factors. There are a growing number of interventional tools providing both physiological and anatomical delineation of disease burden which can help determine method and extent of revascularization. A tailored approach is required taking into consideration shared decision making, co-morbidities and evolving treatment options. AREAS COVERED: This review article explores the wide array of revascularization techniques of both the culprit lesion and non-culprit lesions in the setting of acute myocardial infarction. A scoping literature review was undertaken of the Pubmed database using key words highlighted below. EXPERT OPINION: Prompt and durable revascularization of the infarct-related coronary artery remains the cornerstone of treatment for acute myocardial infarction. Specifically, timely restoration of normal flow and implantation of a DES during the index procedure remains the gold standard; however, deferred treatment and novel devices such as DCB may have an emerging role. Despite much evidence, complete revascularization of non-culprit coronary artery disease in acute myocardial infarction is still the subject of contention.