[The changing role of the coronary care unit cardiologist].

Towards the beginning of the last century, the main role of the cardiologist was in the art of diagnosis and treatment of valvular and congenital heart disease and heart failure. This was transformed around 50 years ago with the discovery of the potential benefits of closed cardiac massage and defibrillation in the management of acute myocardial infarction (MI). Indeed, the consequent development of the coronary care unit (CCU) to allow monitoring and rapid treatment of potentially lethal arrhythmias in acute MI is regarded by many as one of the greatest innovations in cardiology. Subsequently, exciting technological advancement in the invasive treatment of coronary artery disease has led to the focus of cardiologists being primarily on this field, and in particular revascularisation. Since its foundation, the demographics of patients admitted to the CCU have changed significantly, with a reduction in the incidence of ST elevation MI, an increased incidence of non-ST elevation MI, and larger numbers of patients presenting with haemodynamic instability related to other cardiovascular conditions. Further, the patient population is increasingly elderly and with greater comorbidities. With these changes it is apparent that the roles of both the CCU and the cardiologist responsible for managing the acutely unwell cardiac patient also need to change.