The main goal of therapy in ischemia of any type (myocardial infarction, cerebrovascular accident, limb malperfusion and organ transplantation, to name a few) is to restore blood flow to the affected area as quickly as possible. In the situation of a myocardial infarction, “time is muscle,” and this is the basis for trying to restore perfusion within 90 minutes of a patient presenting to the hospital with an ST-segment elevation myocardial infarction. If the LAD is completely occluded and there is no flow to the LAD territory through either the native vessel or collateral vessels, a large area of muscle will become ischemic and damage will be done every minute that blood flow is not restored. While early damage is reversible, this becomes less likely as the period of ischemia lengthens. Guidelines exist to help practitioners provide the best care to their patients. They are typically based on strong medical evidence, but are sometimes based purely on expert opinion. Regardless, they are not comprehensive to the point that they can cover every scenario, and they do not absolve the practitioner from the need to appropriately apply the guidelines when making a decision about a particular patient.
Prompt restoration of flow to the myocardium is a critical component of the management of an acute ST-segment elevation myocardial infarction (STEMI). The mechanism of restoration is less important, and must take into account local resources, patient-specific characteristics and the likelihood of success or injury with each option. Per guidelines, surgical revascularization is a Class I indication when percutaneous options are unsuccessful or contraindicated.
Blood flow restoration after cardiac ischemia medical expert witness specialties include cardiology, interventional cardiology, cardiovascular surgery, and cardiac anesthesiology.