Advanced Strategies in Myocardial Infarction Management: From PCI to Predictive Tools

The landscape of myocardial infarction (MI) management is evolving. From timely primary PCI to emerging CMR-derived markers that anticipate risk, practice is shifting from rescue to precision.

The role of Percutaneous Coronary Intervention (PCI) in managing ST-elevation myocardial infarction (STEMI) cannot be overstated. In observational cohorts, primary PCI has been associated with improved survival among patients with inpatient-onset STEMI, though outcomes remain poorer than community-onset cases. Timely primary PCI reduces mortality compared with fibrinolysis when reperfusion delays are minimized. The magnitude of benefit depends on time-to-reperfusion.

Achieving timely intervention amid comorbid conditions remains a major challenge—including delayed recognition, activation workflow gaps, and competing clinical priorities—especially when systemic barriers overshadow clinical urgency. Inpatients with STEMI face unique obstacles, from recognition delays to coordination hurdles, which complicate the deployment of PCI.

Yet not all sexes experience these benefits equally, highlighting critical disparities in craft and outcome. Women often encounter delays in diagnosis and elevated risks during PCI, necessitating a closer look at sex-specific treatment pathways to bridge these gaps.

Beyond intervention, these imaging insights open avenues for proactive care, refining post-MI management strategies. CMR-derived atrial strain is a promising marker for cerebrovascular risk stratification, but requires further validation and standardization. This tool empowers clinicians to preemptively tailor their approach to post-MI care.

Such insights recalibrate the clinical approach to post-MI surveillance, integrating precision so clinicians can tailor future interventions—complementing timely PCI and addressing recognition gaps that contribute to disparities. Advanced cardiac imaging, such as CMR, offers several advantages, providing comprehensive assessments that can inform clinical decision-making.

Key Takeaways:

• Timely primary PCI is central to STEMI care and, when delays are minimized, is associated with lower mortality compared with fibrinolysis.
• Effective PCI implementation is challenged by systemic and clinical barriers, requiring streamlined protocols and coordination.
• Sex disparities necessitate attention in MI treatment to ensure equitable outcomes post-PCI.
• Emerging CMR-derived markers, such as atrial strain, may help predict cerebrovascular risk post-MI, but need further validation.