Summary of Symposium on New Drugs and Devices
This has been a very exciting and informative meeting. Dr. Reimer told us that if we don’t do something by 3 hours after an MI that the cardiac cells are going to be irreversibly damaged. We also heard about a lot of very sophisticated ways to define infarct size such as electrocardiographic, echocardiographic, enzymatic, positron tomography and radionuclides. All of these methods under optimal circumstances can predict in a reasonably quantitative way, how much of the myocardium is actually infarcted. But conditions have to be very optimal, otherwise all of the infarct sizing techniques break down particularly when you have multiple infarctions, hypertrophy or other cardiac problems. It was very interesting to hear whether lidocaine, streptokinase, the vasodilators, and the calcium blockers can improve cardiac performance during and after an MI. I think that none of these compounds have been as good as we would like them to be. Dr. Campbell pointed out when you consider all the different evaluations that have been done on a given drug that you often find that the clinical trial aren’t as nice and clean as you might like. In some ways that is not bad because if the pharmaceutical companies had been so fortunate as to find the magic bullets to get rid of all cardiac problems then many of us would be out of a job. It has been said that digitalis has probably created more jobs than lives it has saved. I think there is some truth to that. The comment that some drugs are given as much because they have few side effects as for their direct cardiac effects also has some truth.