Rising to the challenge: transforming the treatment of ST-segment elevation myocardial infarction.

CMAJ • JULY 8, 2003; 169 (1) 35 The care of patients with ST-segment elevation myocardial infarction (STEMI) is continually evolving. In the early 1960s, typical care involved primarily bedrest with few, if any, interventions. This was followed by an era of closer observation in coronary care units but still little in the way of beneficial medical interventions apart from prompt cardioversion of lethal arrhythmias. More recently, typical care has evolved to incorporate acute treatment with ASA, heparins, β-blocking drugs, angiotensinconverting-enzyme inhibitors and thrombolytic agents. This evolution toward new, efficacious therapies has been accompanied by a decrease over time in the rate of death from myocardial infarction — a good news story. Many innovations in the treatment of myocardial infarction encountered resistance or delays in uptake. β-Blocking agents were not unanimously endorsed at the outset. Similarly, the use of thrombolytic agents only became a recommended standard of care for STEMI in the late 1980s and early 1990s, about 13–14 years after cumulative analysis of existing trials firmly established its benefit. Rising to the challenge: transforming the treatment of ST-segment elevation myocardial infarction