Myocardial Infarction :: Can the future repeat the past successes?

Early mortality rates for ST-segment elevation myocardial infarction in randomized trials have decreased dramatically over the past 20 years, from 13-percent one-month mortality in 1986 to less than 4 percent today.

This 70-percent drop occurred during the reperfusion era in which great technological advances in treatment of early presenting patients sprang from key observations made by researchers in the late 1970s and early 1980s.

Will attendees at Scientific Sessions in 2026 be congratulating themselves on a similar 70 percent decrease in early mortality? That would put the STEMI early mortality rate at about 1 percent.

?Is this possible? Probably not,? said Frans Van de Werf, M.D., Ph.D., professor and chair of cardiology at Gasthuisberg University Hospital, Leuven, Belgium, in his Paul Dudley White International Lecture on Tuesday. ?Nevertheless I believe that progress can still be made through two potential avenues ? by trying to improve tissue-level reperfusion, and by cell therapy.?

Following the title of Dr. Van de Werf?s lecture ? ?ST-segment elevation acute MI: From reperfusion to regeneration of myocardial tissue? ? he addressed reperfusion first, saying 30 percent to 50 percent of patients with TIMI-3 flow do not have reperfusion.

Shorter delays and renewed studies of adenosine and inhaled nitric oxide might improve reperfusion rates, he said.

Stem cell research is much talked about, but Dr. Van de Werf said more attention should be paid to local administration, or peri-infarct delivery.

Dr. Van de Werf made some sobering observations.

?I don?t know whether we can improve tissue reperfusion, and to date we are nowhere with tissue regeneration,? he said.

Another sobering observation he made is that the percentage of patients not receiving recannalization therapy has not increased over the years.

?The percentage of patients that should be treated with reperfusion and recannalization has remained the same from 2000 to 2004,? he said. ?It is also important to know that out-of-hospital death rates remain high and have not changed significantly between 1990 and 2001.?

Dr. Van de Werf said that although scientists in cardiology have been very successful in developing effective recannalization therapies for STEMI, many patients today still do not receive this therapy and that pre-hospital mortality remains a major issue. ?The development of effective treatments to improve tissue-level reperfusion or to regenerate new myocardium will be much more difficult and will require a long-lasting, concerted effort throughout the world,? he said.

In his introduction to the lecture, American Heart Association President Raymond J. Gibbons, M.D., said Dr. Van de Werf?s research over the years has focused on coronary reperfusion, antithrombotic therapies, left ventricular function and cardiac imaging.

?A pioneer in evidence-based cardiology, Dr. Van de Werf has been a principal investigator or co-principal investigator on several landmark trials including GISSI-II International, GUSTO-I, COBALT, ASCENT, PARADIGM and VALUE,? Dr. Gibbons said.

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