CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Biography Historical Article
Pioneering Alberta cardiac surgeons walked into uncharted territory 40 years ago.
When Dr. John Callaghan performed Canada's first successful open-heart surgery in Edmonton in 1956, the operation took 10 hours and the heart-lung pump he used looked like it had come from the shelves at Canadian Tire. Today the operation takes a couple of hours and the heart-lung pumps used cost $150,000. This article discusses Calaghan's pioneering work, which was recently honoured by University Hospital in Edmonton.
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Clinical Trial Controlled Clinical Trial
Time to treatment with thrombolytic therapy: determinants and effect on short-term nonfatal outcomes of acute myocardial infarction. Canadian GUSTO Investigators. Global Utilization of Streptokinase and + PA for Occluded Coronary Arteries.
To characterize the extent of delay in administration of thrombolytic therapy to patients with acute myocardial infarction (AMI) in Canada, to examine patient-specific predictors of such delay and to measure the effect of delay on short-term nonfatal cardiac outcomes. ⋯ After arrival at a hospital, Canadian patients enrolled in GUSTO-I received thrombolytic therapy more slowly than trial enrollees in other countries. Such delays are already known to decrease the rate of short-term survival after AMI. The findings further show that long time to treatment also increases the odds of nonfatal, serious cardiac events. Hospitals and physicians caring for patients with AMI should routinely assess whether and how they can improve door-to-needle times.
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Comment
Thrombolysis after acute myocardial infarction: are Canadian physicians up to the challenge?
Acute myocardial infarction (AMI) evolves as a time-dependent wave front of ischemia when the abrupt rupture of an unstable fatty plaque initiates coronary thrombosis. The prospect of salvaging potentially viable myocardial tissue has led to the development of reperfusion strategies using thrombolytic agents. The efficacy of thrombolytic therapy is determined in large measure by the speed with which it is initiated. ⋯ Jafna L. Cox and associates report that Canadian centres participating in the GUSTO-I trial were significantly slower to initiate thrombolytic therapy than their US counterparts. In this editorial Cox and associates' report is reviewed against the background of similar trials, and strategies to minimize delays in the initiation of thrombolytic therapy are suggested.
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Physician leaders will meet in Ottawa Feb. 28 and Mar. 1 for the CMA's 9th Annual Leadership Conference to examine how evidence, research and data influence health policy. For information or to register contact CMA Meetings and Travel Department, 800 663-7336, ext. 2274; fax 613 731-8047.