More than one million patients have an acute myocardial infarction in the United States annually and more than 40% of these patients die within the first hour. Of those admitted to the hospital, approximately 15% die during hospitalization. Additionally, more than one million patients with symptoms suggestive of acute myocardial infarction are admitted annually to coronary care units. In the year 2000 more than 12 million people died because of cardiovascular disorders mainly caused by atheroma and subsequent thrombosis (atherothrombosis). It is estimated that in the year 2025 more than 24 million people will die from this disease in a world population of approximately 7.4 billion. Intensive research is required to prevent atherothrombosis rather than the management of its complications which include fatal and nonfatal heart attack, angina, heart failure, abdominal aortic aneurysm, stroke, kidney failure, and peripheral vascular disease causing intermittent claudication and gangrene of the lower limb.
Most of the research done in major institutions in the United States and in developed countries is directed at the management of complications of atherosclerotic coronary artery disease. The advent worldwide of coronary care units in the early seventies, thrombolytic agents in the late eighties, coronary angioplasty in the eighties and nineties, and stents during the past decade have improved survival but this can be considered ‘‘a spit in the ocean expecting the tide to rise.’’ The development of left ventricular assist devices (that are clearly bridge to transplantation and not artificial hearts) requires considerable financial support for their development, but they will save less than 4000 lives annually worldwide. [See the chapter, Artificial heart]