The Long March into Clinical Practice: Cardiac CT and Its Competitors

Abstract

In the early twentieth century, control of infectious diseases, increasing longevity, and poor lifestyles resulted in chronic diseases becoming the major cause of disability and death. By the 1920s, coronary artery disease (CAD) became the leading cause of death in the United States. As treatments emerged to treat CAD, it became important to develop means for identifying those patients at risk for developing the disease and its complications. Initial diagnostic work in this regard was initiated even prior to the advent of exercise electrocardiography. In the 1920s, Master developed his famous “two-step” stress test, which allowed physicians to assess patients’ functional capacity in a semiquantitative manner and to provoke angina symptoms through physical activity. In the 1950s, treadmill testing was implemented, and in 1963, Robert Bruce published his protocol for performing graded multistage treadmill exercise with electrocardiographic monitoring, a protocol that is still used today. This development of the Bruce protocol treadmill exercise was timely since the 1960s saw the introduction of cardiac catheterization and coronary bypass surgery. With this dramatic new treatment option, a need emerged to accurately identify those patients who were at risk for cardiac events and thus potential beneficiaries of coronary artery bypass surgery.