The role of surgery in ongoing infarction.

Acute coronary syndromes range in severity from unstable angina to evolving myocardial infarction with persistent ST-segment elevation, with or without cardiogenic shock. Despite major improvements in medical and percutaneous therapy, acute coronary syndromes still represent a major cause of morbidity and mortality. The aggressive approaches to myocardial revascularization and mechanical circulatory support reviewed in this article seem to reduce the mortality associated with acute coronary syndromes. The optimal timing of surgery should not only reduce short-term mortality but also improve long-term outcomes.