The coronary care unit. New perspectives and directions

In the past two decades there have been momentous advances in the care of patients with cardiovascular ailments. Yet, mortality from coronary-artery disease has remained unaffected. Year after year myocardial infarction and its complications exact the highest toll of any single disease.¹In large metropolitan hospitals, the death rate from this condition 30 years ago ranged from 30% to 40% and remains unaltered today. Certain facts are forcing reevaluation of the problem. Peak mortality occurs at the very onset of myocardial infarction and then recedes almost exponentially, with 65% of deaths occurring in the initial three days and 85% during the first week of attack. Arrhythmias probably account for 40% of deaths. Of these about two thirds are due to ventricular fibrillation and one third to bradycardia, heart block, and asystole.²It is well established that these electrical catastrophes are usually not due to irreversible cardiac damage. On