The past 50 years have witnessed a breathtaking evolution in the
approaches to the patient with an acute ST elevation myocardial
infarction. In the 1960s, the now commonplace cardiac intensive care
unit was but a nascent idea. Without much to offer the patient but weeks
of absolute bedrest, substantial morbidity and high rates of mortality
were the norm. Just 30 years ago, seminal discoveries by DeWood and
colleagues suggested that the culprit was plaque rupture with
thrombosis, not progressive luminal compromise. Subsequent fibrinolyt-
based strategies resulted in a halving of the mortality of acute
myocardial infarction. With the introduction of balloon angioplasty in
the late 1970s, a few interventional cardiologists braved the question:
why not perform emergency angioplasty as a primary reperfusion strategy?
Indeed, reports of successful reperfusion via balloon angioplasty
appeared (mostly in local newspapers) as early as 1980. Despite being
thought of as heretical by mainstream cardiology, these pioneers
nonetheless persevered, proving the benefit of ''state-of-the-art''
balloon angioplasty compared with ''state-of-t- art'' thrombolytic
therapy in a series of landmark trials published in the New England
Journal of Medicine in March of 1993. Publication of the first edition
of Primary Angioplasty in Acute Myocardial Infarction in 2002 to some
extent anticipated the widespread acceptance of primary percutaneous
coronary intervention as the standard of care. Since then, in all
respects, the evolution of emergency percutaneous revascularization has
only accelerated. The universal replacement of balloon angioplasty with
stent implantation was clearly one key.
