Elsevier

The Lancet

Volume 352, Issue 9142, 28 November 1998, Pages 1771-1774
The Lancet

Department of Medical History
Evolution of the management of acute myocardial infarction: a 20th century saga

https://doi.org/10.1016/S0140-6736(98)03212-7Get rights and content

Section snippets

The coronary care unit

The coronary care unit (CCU), the single most important advance in the treatment of AMI, came about as a result of four separate developments: the appreciation of the importance of arrhythmias as the principal cause of early death in AMI; the ability to monitor the ECG continuously with the cathode-ray oscilloscope, a device that had been greatly improved by the military during World War II; the development of closed-chest cardiac resuscitation;11 and the delegation of the treatment of

Prehospital care

Most deaths in patients with AMI are caused by arrhythmias and occur before the patient reaches the hospital. Therefore, efforts have been directed towards making available to patients some of the benefits of the CCU, especially the treatment of ventricular tachycardia and ventricular fibrillation before they reach hospital.15 Ambulances staffed by trained personnel and equipped with ECG monitors, drugs, and equipment for defibrillation and resuscitation have saved many lives.

Limitation of infarct size

Left ventricular

Current challenges and opportunities

Application of the various therapeutic measures outlined above—either alone or in combination—has reduced the early (1 month) mortality rate of patients admitted to hospital with AMI by about two-thirds since 1960. However, it is still prohibitively high—about 10% (around 7% in patients eligible for and receiving early reperfusion therapy)—and seems to have reached a plateau, perhaps because continued therapeutic advances have been offset by the more advanced age and increasing co-morbidities

Conclusions

At the beginning of the 20th century, AMI secondary to acute thrombotic coronary occlusion was regarded as a rare condition not compatible with survival. As this century draws to a close, AMI is recognised as one of the most common serious illnesses in industrialised nations. The lives of patients with AMI can be substantially prolonged and improved by the prompt recognition and treatment of cardiac arrhythmias and heart failure. Aspirin and β-blockers also reduce early mortality and infarct

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