The Message Is Clear

The ultimate goal of all cardiovascular clinical research should be to reduce the morbidity and mortality from cardiovascular diseases at an acceptable cost. In no area of medicine has clinical research led to a greater change in medical care than in the management of acute myocardial infarction (AMI). We now try to accomplish early coronary reperfusion in all ST-elevation MIs and administer a combination of drugs in the postinfarction period to halt or slow the progressive remodeling process that leads to heart failure and shortened survival.1 Clinical trials have documented the dramatic efficacy of these therapeutic interventions on morbidity and mortality.2–5Article see p 2577The old nontherapeutic approach was not so long ago. During my internship in Boston in 1956, my first admission was a middle-aged man with an acute transmural anterior wall MI. After ministering to him for his 4-week hospital stay, which was mandatory in those days, he went home stable, only to return in 6 months with fulminant heart failure that took his life. What happened to him in that 6 months was mysterious to me, as well as to my Harvard attending physicians, who viewed the patient’s course as a rather uninteresting response to heart damage. It was 30 years before the concept of structural remodeling became recognized and effectively treated.6Chin et al7 in this issue of Circulation explore changes in the course of patients like mine as a consequence of our new aggressive therapeutic approach. They used a complete national sample of AMI hospitalizations in nearly 3 million …