Innovations in the Treatment of Acute Myocardial Infarction in the Era of Precision and Intelligence: Transitioning From Reperfusion Strategies to Regenerative Medicine

Acute myocardial infarction (AMI) remains a global health challenge. This has driven innovation toward precision medicine, including major advances in several key areas. Precision Reperfusion: Intravascular ultrasound (IVUS), optical coherence tomography (OCT) and fractional flow reserve (FFR) can be used to optimize stent deployment, thereby reducing thrombosis and restenosis. Bioabsorbable stents and drug-coated balloons (DCBs) show promise in minimizing long-term complications. Mechanical Circulatory Support (MCS): Early use of Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to improve survival in select AMI-cardiogenic shock patients, although device selection and timing require further validation. Antiplatelet Personalization: Genotyping (e.g., CYP2C19) and testing of platelet function enables tailored dual antiplatelet therapy (DAPT), thus balancing ischemic and bleeding risks. Regenerative Therapies: Extracellular vesicles (EVs) from stem cells or cardiac progenitors have shown cardioprotective effects in preclinical models, addressing limitations of cell-based approaches. Artificial intelligence (AI)-driven platforms can optimize EV delivery and tissue repair. AI-Enhanced Diagnostics: Machine learning models improve Electrocardiogram (ECG) interpretation, risk stratification, and the detection of ST-segment elevation myocardial infarction (STEMI). This review aims to provide a theoretical foundation for practical clinical applications in the treatment of AMI.