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Expert discusses past, present and future of MI care
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CHICAGO — In 1912, James Herrick, MD, published the first paper describing the clinical features of two patients with MI. As 2012 marks the centennial anniversary of this landmark publication, Eugene Braunwald, MD, said now is the time to recognize important advances in the field.
“[This paper] is one of the most important in the recent history of cardiology,” he said during the Simon Dack Lecture at the American College of Cardiology’s 61st Scientific Sessions. “This is an appropriate time to review the extraordinary findings and advances in the therapy of acute MI and look ahead at what’s to come.”
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Historical perspective
A primary problem in the early treatment of MI was a high 30% in-hospital mortality rate in patients with the condition — a number that did not include those who died before hospital admission, Braunwald said. The solution, and the first major therapeutic advance in MI, occurred in 1961 with the creation of the coronary care unit. Patients with acute MI were segregated and carefully monitored with alarms. This new unit cut the mortality rate in half, Braunwald said.
A number of other advances followed the creation of the coronary care unit, including reperfusion therapy, which has been associated with a 75% decrease in mortality during a 25-year period; the addition of aspirin to the treatment regimen for MI; balloon angioplasty; and stenting. Still, MI remains a concern, according to Braunwald.
“Despite these advances, MI remains a major health problem with almost 1 million new cases a year in the US,” said Braunwald, who is Distinguished Hersey Professor of Medicine at Harvard Medical School. “We cannot rest on our laurels.”
Looking ahead
Several developing areas of therapy for MI are on the horizon, Braunwald said. Researchers are investigating preconditioning before occlusion and pharmacological treatments, such as cyclosporine, to prevent myocardial reperfusion injury. Additionally, post-MI inhibition of thrombin generation, which can persist for months after an acute event, is being studied as another therapeutic approach. The addition of rivaroxaban (Xarelto, Janssen) to dual antiplatelet therapy has shown success in trials such as ATLAS-ACS, and appears to be useful in preventing thrombin generation, he said.
Post-acute MI cell therapy has also become an exciting avenue for exploration, he noted. Results from recently published trials, such as SCIPIO and CADUCEUS, demonstrate the potential of using cardiac stem cells to repair the heart and improve function after CV events.
“It is interesting to look back 100 years at Herrick’s description and to observe great advances in treatment that have occurred,” Braunwald said. “I am confident that these and other therapeutic, inventive options will help to bring this important condition under more control early during the second century after Herrick’s seminal paper.” – by Melissa Foster
For more information:
- Braunwald E. Simon Dack Lecture: The treatment of acute myocardial infarction — Into the second century. Presented at: the American College of Cardiology 61st Scientific Session & Expo; March 24-27, 2012; Chicago.