Abstract: Objective To analyze the roles of pathological changes in mitochondrial homeostasis during the progression of myocardial infarction (MI), and to summarize the latest research advances in improving MI by traditional Chinese medicine (TCM) via the regulation of mitochondrial homeostasis in order to provide data for prevention and treatment of MI through mitochondrial protective pathways. Methods Recent literature on MI and mitochondrial homeostasis was retrieved before the core pathological roles of mitochondrial homeostatic imbalance in MI were analyzed and advances in experimental studies on the ability of TCM to improve MI by regulating mitochondrial function through multi-target mechanisms were outlined. Results Recent studies suggested that mitochondrial homeostatic imbalance was a major pathological mechanism for MI, which manifested itself in impaired oxidative phosphorylation, ROS burst, Ca²⁺ overload, mitochondrial permeability transition, abnormal mitochondrial dynamics, dysregulated mitophagy, and mitochondria-mediated activation of cell death pathways. By targeting abnormal mitochondrial homeostasis in cardiomyocytes and the consequent imbalance of both mitochondrial network remodeling and the mitochondrial quality control system, TCM formulas, single herbs, and active compounds could exert multilevel, multi-pathway, and multitarget synergistic effects that helped alleviate mitochondrial injury, maintain mitochondrial homeostasis, reduce cardiomyocyte apoptosis, improve myocardial function, and attenuate ventricular remodeling. Conclusion Mitochondrial homeostatic imbalance is pathologically critical to MI progression. TCM has a cardioprotective potential by regulating mitochondrial homeostasis through multicomponent, multitarget actions. This study is expected to provide insights into MI prevention and treatment strategies based on mitochondrial protection.

Key words: Myocardial Infarction, Mitochondrial Homeostasis, Traditional Chinese Medicine, Mitochondrial Quality Control, Pathological Mechanisms