Editorial

A Brief History of Emergency Intervention for Acute Myocardial Infarction

Phillips SJ*
Department of Cardiology, National Institutes of Health, USA


*Corresponding author: Phillips SJ, Department of Cardiology, National Library of Medicine, National Institutes of Health, US Department of Health & Human Services, 6707 Democracy Boulevard, Suite 510, Bethesda, USA


Published: 10 Aug, 2017
Cite this article as: Phillips SJ. A Brief History of Emergency Intervention for Acute Myocardial Infarction. J Heart Stroke. 2017; 2(5): 1037.

Editorial

Enhancements in the management of acute and chronic disease typically evolve over time. Sporadically, a quantum leap in the management of a malady can result in a significant improvement in outcomes. In 1876 Adam Hammer [1,2] postulated that a myocardial infarction was instigated by the interruption of blood flow into a coronary artery. Not with standing Hammer’s advice the management of unstable Coronary Artery Disease, (CAD) including Acute Myocardial Infarction (AMI), was traditionally managed conservatively with therapies designed to treat symptoms and sequelae, and not the cause. Symptomatic management alone resulted in an in-hospital AMI mortality between 15% to 30 % with survivors demonstrating significant residual morbidities, and late mortality. The modern era of cardiac surgery was ushered in with the development of the heart-lung machine [3-6]. The 1960’s and beyond saw great advances in coronary artery bypass surgery (CABG) [7-9]. These advances ushered in at first, the era of surgical management of chronic, stable CAD, followed by the surgical management of unstable CAD [10-12]. During the mid 1970’s, the conventional management for AMI made the quantum leap from treating symptoms and sequelae, to treating the cause [13,14]. The cause, first postulated by Hammer a century earlier, was confirmed in 1975, as the sudden occlusion of a coronary artery by a clot generated from a ruptured atherosclerotic plaque [15]. Reports published by Berg et al. [13] and this author demonstrated that rapid intervention with CABG resulted in a significant reduction in morbidity and mortality as compared to conventional management. Emergency reperfusion using CABG as a treatment of AMI reduced the in hospital mortality in my institution from approximately 29% to 1.3%, with a late mortality of 2.8% [14,15]. The value of emergency CABG to reintroduce blood flow into the MI vessel, salvages myocardium, improves myocardial function and permits the bypassing of other diseased coronary arteries. Though initially critiqued we and others continued treating AMI as an extreme emergency analogous to treating a gunshot wound of the abdomen or an aortic rupture [16-24]. The pre op emergency coronary angiogram typically demonstrated a total occlusion or a significant filling defect (clot) in the culprit coronary artery. At surgery, we routinely inserted a small balloon tipped catheter into that vessel to extract clot and frequently, atherosclerotic debris [15]. The revelation that clot, generated by a ruptured plaque, caused the MI, predated but paved the way for thrombolytic and percutaneous coronary intervention (PCI) therapies [25,26]. Emergency PCI [27] is to days accepted and preferred standard of care for the entire spectrum of CAD, including unstable CAD and AMI. PCI is one of the most commonly performed medical interventions. The concept of reperfusion is central to the modern treatment of CADs a general rule, the initial therapy for AMI is directed toward restoration of perfusion as soon as possible to salvage as much of the jeopardized myocardium as possible. This may be accomplished through mechanical means, such as PCI, or CABG surgery.


References

  1. Lie JT. Centenary of the first correct antemortem diagnosis of coronary thrombosis by Adam Hammer (1818--1878): English translation of the original report. Am J Cardiol.1978;42(5):849-52.
  2. Wilson C, Gilmore R, Morrison T. Aberrant membrane insertion of a cytoplasmic tail deletion mutant of the hemagglutinin-neuraminidase glycoprotein of Newcastle disease virus. Mol Cell Biol. 1990;10(2):449-57.
  3. Gibbon JH. Artificial maintenance of circulation during experimental occlusion of pulmonary artery. Arch Surg. 1937;34(6):1105-31.
  4. Gibbon JH. Application of a mechanical heart and lung apparatus to cardiac surgery. Minn Med. 1954;37(3):171-85.
  5. Zimmer HG. The Isolated Perfused Heart and Its Pioneers. News Physiol Sci. 1998;13:203-10.
  6. Gibbon JH. Development of the artificial heart and lung extracorporeal blood circuit. JAMA. 1968;206(9):1983-6.
  7. Goetz RH, Rohman M, Haller JD, Dee R, Rosenak SS. Internal mammary-coronary artery anastomosis. A nonsuture method employing tantalum rings. J Thorac Cardiovasc Surg. 1961;41:378-86.
  8. Kolesov VI, Potashov LV. Surgery of coronary arteries. Eksp Khir Anesteziol. 1965;10(2):3-8.
  9. Captur G1. Memento for René Favaloro. Tex Heart Inst J. 2004;31(1):47-60.
  10. Favaloro RG, Effler DB, Cheanvechai C, Quint RA, Sones FM Jr. Acute coronary insufficiency (impending myocardial infarction and myocardial infarction): surgical treatment by the saphenous vein graft technique. Am J Cardiol. 1971;28(5):598-607.
  11. Roberts R, Sobel BE. Coronary revascularization during evolving myocardial infarction -- the need for caution. Circulation. 1974;50(5):867-70.
  12. Bolooki H, Vargas A. Myocardial revascularization after acute myocardial infarction. Arch Surg. 1976;111(11):1216-24.
  13. Berg R, Kendall RW, Duvoisin GE, Ganji JH, Rudy LW, Everhart FJ. Acute myocardial infarction: a surgical emergency. J Thorac Cardiovasc Surg. 1975;70(3):432-9.
  14. Phillips SJ, Zeff RH, Kongtahworn C. Emergency myocardialrevascularization during acute myocardial infarction. Assoc Thorac Cardiovasc Surg of Asia. 1976;10:23.
  15. Phillips SJ, Kongtahworn C, Zeff RH, Benson M, Iannone L, Brown T, et al. Emergency coronary artery revascularization: a possible therapy for acute myocardial infarction. Circulation. 1979;60(2):241-6.
  16. McIntosh HD, Buccino A. Editorial Emergency Coronary Artery Revascularization of Patients with Acute Myocardial Infarction. You Can. But Should You? Circ. 1979;60(2).
  17. Phillips SJ, Zeff RH, Kongtahworn C, Skinner JR, Iannone L, Brown TM, et al. Surgery for evolving myocardial infarction. JAMA. 1982;248(11):1325-8.
  18. Skinner JR, Phillips SJ, Zeff RH, Kongtahworn C. Immediate coronary bypass following failed streptokinase infusion in evolving myocardial infarction. J Thorac Cardiovasc Surg. 1984;87(4):567-70.
  19. Phillips SJ, Kongtahworn C, Skinner JR, Zeff RH, Toon RS. Role of surgery in evolving myocardial infarction. Applied Cardiology. 1985;23-9.
  20. Phillips SJ, Zeff RH, Skinner JR, Toon RS, Grignon A, Kongtahworn C. Reperfusion protocol and results in 738 patients with evolving myocardial infarction. Ann Thorac Surg. 1986;41(2):119-25.
  21. Phillips SJ. Intervention in acute ischemia: surgery in evolving acute infarction. In: Wheatley, David J, editors. Surgery of Coronary Artery Disease. 1986. p.489-502.
  22. Phillips SJ, Roberts AJ, Conti CR. Surgery for evolving myocardial infarction. Advances in Cardiovascular Surgery. 1987.
  23. DeWood MA, Spores J, Notske RN, Lang HT, Shields JP, Simpson CS, et al. Medical and surgical management of myocardial infarction. Am J Cardiol. 1979;44(7):1356-64.
  24. Gruentzig A. Results from coronary angioplasty and implications for the future. Am Heart J. 1982;103(4 Pt 2):779-83.
  25. Barton M, Grüntzig J, Husmann M, Rösch J. Balloon Angioplasty-The Legacy of Andreas Grüntzig, M.D. (1939-1985). Front Cardiovasc Med. 2014;1:15.
  26. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. ESC/EACTS Guidelines on myocardial revascularization; The Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery. Eur Heart J. 2014; 35(37):2541-619.
  27. Myocardial infarction with ST-segment elevation: The acute management of myocardial infarction with ST-segment elevation. NICE Clinical Guideline. 2013.