1975

Automated ECG Interpretation

Hewlett-Packard was among the first companies to develop the technology to measure ECG waveforms and interpret ECG readings. The machines were very large and expensive, about $5,000. In fact, they were so costly at the time that you could lease a machine just like a car ($5,000 is just what the average car cost in 1975) and make monthly payments. Now, all ECG machines have software that interprets the ECG with substantial accuracy at a much lower cost. A study by Hughes et al found that of 222 ECGs interpreted as normal by the Marquette 12SL software, only one, on over-read, was interpreted by one of two emergency physicians as requiring immediate bedding, and the patient had a normal stress test.¹ This is not to say that there are not multiple subtle ECG patterns that are worrisome that can be missed by computerized readings. Thus, review by an experienced clinician is mandatory.

1979

Advent of Thrombolytic Therapy for ST-Elevation Myocardial Infarction (STEMI)

In 1958, Sol Sherry, MD, of Temple University in Philadelphia, started using streptokinase in AMI patients, and he and his colleagues began the era of “cure” versus palliation of myocardial infarction. Bed rest for weeks was the mainstay of treatment at the time. In 1979, K.P. Rentrop, MD, PhD, and colleagues began the use of intracoronary streptokinase infusions.

1986

Widespread Use of Thrombolytic Therapy for STEMI

In 1986, the GISSI trial of 11,712 AMI patients demonstrated that compared to standard care, an IV infusion of 1.5 million units of streptokinase resulted in a 21-day mortality of 10.7 percent versus 13 percent in controls.² The results of this trial prompted progressive initiation of thrombolytic therapy, but it took at least 10 years until the practice was broadly available. The gap between when thrombolytic therapy was first found to be beneficial and the widespread adoption of its use is a classic example in which knowledge translation moved very slowly. Unfortunately, many patients who could have benefited from thrombolysis did not receive it and, as a result, suffered needless mortality, recurrent myocardial infarctions, and heart failure.

1988

Demonstration of the Benefit of Both Aspirin and Thrombolysis for STEMI

In August 1988, the results of the 17,187-patient ISIS-2 trial demonstrated that aspirin, 180 mg daily given for one month, resulted in a reduced five-week vascular mortality in AMI patients compared to standard care (9.4 percent versus 11.8 percent, a 21.³ percent relative reduction).3 The results produced by streptokinase alone were virtually identical to those produced by aspirin (9.2 percent versus 12 percent). As anticipated, the combination of aspirin and streptokinase was superior to either treatment alone (8 percent versus 13 percent). This study reaffirmed the efficacy of aspirin and solidified its crucial role in the treatment of all patients suspected of having cardiogenic chest pain.