45 years in the business (Bill Roberts part 2)

In addition to dissecting, like the good pathologist he is, the status of cardiovascular journals (see previous post in this blog),  Bill Roberts, AJC editor, looks back on 45 years in the cardiovascular arena. In 1963  he was a cardiology fellow under Braunwald at the NIH. Roberts writes:

That was the year President John F. Kennedy was killed in Dallas, Texas. When he arrived at Parkland Hospital, there was no electrocardiograph in the emergency room. What has occurred in cardiovascular medicine since that fatal November day in 1963 is astounding! No specialty in medicine has had such a transformation.

One milestone Roberts discusses is thrombolysis, which caused a true revolution in cardiology in the early 1980s after Peter Rentrop gave an intracoronary injection of streptokinase to a patient with AMI and stopped the evolving MI in its tracks. Although thrombolytic therapy never lived up to its earliest promise, in its earliest days it initiated the “Age of Reperfusion” in which we still live, and which transformed the practice of cardiology from a largely intellectual pursuit to an “interventional” specialty in the largest sense of the word.

But Roberts doesn’t mention his own intriguing role in this revolution. Many years ago Rentrop told me his story about the early days of thrombolysis, and talked about the critical role Roberts inadvertently played. 

Although Roberts was “one of the smartest people I know,” according to Rentrop, he played a key role in convincing the cardiology community that clots were not the proximate cause of MI. As a pathologist at the NIH, Roberts performed post-mortems on MI patients, and “came to the conclusion that only half of them had clots, and the later he got there the more frequent there were clots, and if there was shock they almost always had clots.” Roberts concluded, then, “that the clot occurs late as a result of low blood pressure but is not the cause of a heart attack.” Rentrop said that “Roberts was a brilliant man. The paper “was beautifully and convincingly presented. He showed that people who had sudden death never had a clot….  now we know that people with sudden death didn’t have heart attacks, they died from arrhythmias, but we didn’t know that then.”

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