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Review
Article Celebrates the Early Days of the Clot-Buster
Revolution
(Jun. 1, 1999) In a review article in the June issue
of the Journal of the American College of Cardiology,
one of the early pioneers of the clot-buster revolution
looks back at a key study from the 1980s that helped
launch the first widely available and effective treatment
for heart attacks.
The article, written by Dr. J. Ward
Kennedy, a former president of the American College
of Cardiology and the principle investigator of the
Western Washington trials of thrombolytic therapy, reviews
a study from the Netherlands by Drs. Maarten Simoons
and Patrick W. Serruys and colleagues.
Prior to the 1980s, cardiologists were unable to effectively
treat heart attacks, which were then and are still the
number one killer in the developed world. In the late
1970s, two studies opened the way to a revolutionary
new approach. Investigators in Spokane, Wash., led by
Dr. Marcus DeWood, provided for the first time convincing
evidence that a blood clot lodged in a coronary artery
was nearly always the cause of a heart attack. Then,
in Germany, Dr. Peter Rentrop showed that the delivery
of intracoronary streptokinase, a clot-dissolving drug,
could stop a heart attack in progress.
Following these two studies, cardiovascular researchers
began an intense international effort to develop thrombolytic
therapy, as it was known, so that it could soon be offered
to heart attack patients. One such effort was Dr. Kennedy's
own Western Washington trials. Another was the Dutch
team's study. In 1981, they began their study in which
533 heart attack patients were randomized to either
conventional therapy or thrombolytic therapy. The results,
which appeared in the April 1986 edition of JACC,
showed that thrombolytic therapy saved lives, reduced
heart attack size, and preserved heart function.
Since the late 1970s, the mortality rate among heart
attack patients who reach the hospital—and therefore
can be treated—has declined dramatically. The mortality
rate among patients receiving conventional therapy was
11.7 percent in the Dutch trial; in the larger GISSI-1
trial, the rate was 13 percent. Today, the mortality
rate is as low as 2–3 percent among patients who undergo
primary angioplasty in the early phase of their heart
attack.
The review article by Dr. Kennedy is part of a series
published in commemoration of the ACC's 50th
anniversary and focuses on studies that were published
in an ACC journal, either the American Journal of
Cardiology (AJC 1958–1982) or JACC (1983–present),
since the College's inception in 1949.
The American College of Cardiology, a 24,000-member
nonprofit professional medical society and teaching
institution, is dedicated to fostering optimal cardiovascular
care and disease prevention through professional education,
promotion of research, leadership in the development
of standards and guidelines, and the formulation of
health care policy.
The American College of Cardiology (ACC) provides these
news reports of clinical studies published in the Journal
of the American College of Cardiology as a service to
physicians, the media, the public, and other interested
parties. However, statements or opinions expressed in
these reports reflect the view of the author(s) and
do not represent official policy of the ACC unless stated
so.
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J. Ward Kennedy, MD, MACC
J. Ward Kennedy, MD, MACC, past president of the American
College of Cardiology (ACC), is professor of medicine
at the University of Washington in Seattle.
Currently, his research efforts are focused on examining
the relationship of chronic infection to the development
of atherosclerosis and heart attack. Dr. Kennedy's early
research activities included the development and application
of quantitative angiographic techniques for the evaluation
of left ventricular function in patients with valvular
and ischemic heart disease. He has also played an active
role in the assessment of coronary artery revascularization
procedures and in the development of thrombolytic therapy
for treating heart attack.
His ACC activities include serving on the ad hoc advisory
committee on risk factor management practices and the
ACC/American Heart Association's committee to revise
the 1993 guidelines for percutaneous transluminal coronary
angioplasty (PTCA). He is also a member of the ACCEL
(American College of Cardiology Extended Learning) editorial
board and the ACC International Committee.
Dr. Kennedy earned his undergraduate degree from Bowdoin
College in Brunswick, Maine, and received his medical
degree from the University of Rochester in New York.
He completed his medical residency and cardiology fellowship
at the University of Washington.
When Dr. Kennedy is not spending time with his wife
and three children, he doubles as an accomplished jazz
trombonist.
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