A contemporary review of myocardial infarction management covers the diagnostic framework, risk stratification and treatment, and critically appraises the evidence on revascularisation strategy - including the timing and guidance of complete revascularisation, which is exactly the question the day's randomised evidence addresses. It restates the system-of-care thresholds that underpin everything else: primary percutaneous coronary intervention where it can be delivered within 120 minutes, fibrinolysis where it cannot.
The part worth the reading time is the emphasis on myocardial infarction without obstructive coronary artery disease. It has moved from a diagnosis of exclusion to an entity with its own workup, and the review treats it that way. The other honest admission is residual risk: a substantial minority have recurrent events despite conventional risk factors being well controlled, which is what drives the interest in adjunctive pharmacology.
In a setting where transfer times routinely exceed two hours, the 120-minute rule is the most consequential line in the document. It is a decision about which hospital the patient should be taken to, made by whoever is arranging transport, and it is frequently made by default.
- Apply the 120-minute rule at the point of transport decision, not on arrival.
- Work up MINOCA as a diagnosis with its own pathway rather than stopping at 'clean coronaries'.
- Review secondary prevention adherence in anyone with a recurrent event before assuming residual inflammatory or lipoprotein risk.
- Document the reason when fibrinolysis is chosen, so the system delay is auditable.
- Use the review to update local protocol wording, not to change an individual patient's plan today.
Why it matters
It puts the question of how to select non-culprit lesions at the centre of infarct care, which is where today's trial evidence lands.
Don't overread it
This is a narrative state-of-the-art review, not a guideline or a systematic synthesis, and carries no new data of its own.
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