- Peter Bogaty, staff cardiologist (peter.bogaty@med.ulaval.ca)1,
- James M Brophy, staff cardiologist2
- 1 Quebec Heart Institute, Laval University, Ste-Foy, Quebec, Canada G1V 4G5
- 2 Royal Victoria Hospital, McGill University, Montreal, Canada
- Correspondence to: P Bogaty
- Accepted 29 March 2004
Myocardial infarction used to be a nasty scourge, with 15-25% mortality. Then came the breakthrough discoveries that thrombotic coronary occlusion caused myocardial infarction and that balloon catheters could cross the occlusion, squash the thrombus, and re-establish flow. Thus, it was possible to abort the progression of myocardial infarction and reduce mortality. Cardiologists became interventionists. Cardiac catheterisation laboratories grew like mushrooms. Balloons and hubris were inflated as many lives were saved. A gigantic industry sprang forth of catheters, sophisticated stents, and expensive adjunctive drugs. It seemed that all was now for the best “in the best of all possible worlds” and “that things in general were settled forever.”
Creaking system
And yet there were downsides. …
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