Despite decades of therapeutic advancements in coronary revascularization—whether by thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) surgery—and hemodynamic support with temporary mechanical circulatory support (tMCS) for those with further complication of shock, acute myocardial infarction (AMI) remains a leading cause of death in Canada and worldwide.1,2 Nearly 70,000 Canadians suffer from AMI, and 5000 die annually within 30 days of admission.2 Emergent CABG is still indicated for those patients with mechanical complications or severe ventricular failure leading to refractory cardiogenic shock (CS), heart failure (HF), or angina post-AMI, but the optimal timing of such surgical coronary revascularization in more stable or less symptomatic patients with AMI remains unclear. The study by Goldberger and colleagues published in this issue of the Canadian Journal of Cardiology3 raises several intriguing and yet unanswered questions: whether risk factors for in-hospital mortality after AMI evolve over time during index hospitalization, whether any identifiable risk factors for death are potentially modifiable, and whether there is an optimal timing for CABG after AMI.
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