Therapeutic translation across myocardial infarction and myocardial contusion: opportunities, boundaries, and bidirectional lessons

This review examines the asymmetric therapeutic relationship between myocardial contusion (MC) and myocardial infarction (MI). Although these two forms of myocardial injury arise from different initiating events, they converge across key secondary injury pathways, including inflammatory activation, oxidative stress, calcium dysregulation, cell death, fibrosis, and ventricular remodeling. Its aim is to clarify which elements of MI generate biologically portable hypotheses for MC, which remain clinically non-transferable, and how trauma reveals the contextual limits of canonical MI care. Evidence was retrieved from PubMed and CNKI primarily covering publications between January 2000 and January 2026 including experimental studies, clinical investigations, imaging studies, and guideline or consensus documents. The comparative literature indicates that the major divergence between MC and MI lies not in the mere presence of myocardial injury, but in the primary insult, the spatial organization of tissue damage, the logic of diagnostic interpretation, and the sequence of therapeutic decision-making. In this context, MI should be regarded not as a directly transferable treatment template for MC, but as a more mature source of mechanism-based hypotheses, particularly for the modulation of inflammatory amplification, oxidative injury, maladaptive remodeling, rhythm-risk surveillance, and biomarker-imaging integration. Conversely, MC is clinically informative less as a therapeutic analogue of MI than as a boundary condition that clarifies the dependence of myocardial injury management on etiology, bleeding risk, structural injury, and competing clinical priorities. Future research should prioritize trauma-specific phenotyping, multimodal diagnostic stratification, biomarker-imaging integration, and prospective evaluation of adjunctive targeted compatible with trauma care without delaying stabilization.