Advances in treating heart attacks

By Dr. Bobby Woo

SINGAPORE (JP): Our knowledge of treating acute heart attacks spans three centuries.

Toward the end of the 19th century, it was established that heart attacks were caused by coronary thrombosis. At the dawn of the 20th century, Dr. Herrick laid the groundwork for treatment when he recommended enforced rest in hospital. This concept of "masterly inactivity" was to remain until the 1960s because of lack of other viable options in management.

But that decade heralded the dawn of new insights in management, with the proven benefits of cardio-pulmonary resuscitation, especially defibrillation of life threatening arrhythmia. In 1961, Dr Desmond Julian introduced the concept of a coronary care unit (CCU) staffed by experienced cardiac personnel with knowledge of cardio-pulmonary resusciation and 24- hour ECG monitoring. Within 3 years, CCUs were established in hospitals worldwide and with it a decrease in mortality of heart attack patients by nearly half, to 15 percent. The salvage was in the successful treatment of malignant arrhythmia.

The last quarter of the 20th century saw attempts at salvage of the remaining 15 percent of in-hospital deaths, which stem from pump failure following an extensive heart attack. Thrombolytic therapy was proven to be effective in decreasing significantly the in-hospital mortality by the Italian group in the GISSI study in 1986. Since then, biotechnological advances have given rise to better "clot busters". It is now an accepted fact that opening a blocked coronary artery will decrease the mortality from 17 percent to about 10 percent.

Towards the end of the 20th century, active intervention was studied to bring about a higher success rate in re-opening blood vessels by means of primary angioplasty and stenting acute heart attacks.

The author is a consultant physician and cardiologist at Gleneagles Medical Center.