MRI scanners gradually introduced, CT scanners and ultrasound machines much improved and more readily available, personal computers and the internet
CK-MB becomes the main biomarker for Dx of AMI
stat 300mg aspirin for suspected heart attacks introduced in early 1990s
AHA/ACC guidelines (1990–1996) recommended UFH IV bolus + infusion alongside aspirin/thrombolysis for STEMI
GP IIb/IIIa inhibitors emerged late 1990s
bare‑metal stents standardised: intracoronary stents moved from innovation to routine practice, markedly reducing acute vessel closure and improving PCI outcomes vs balloon angioplasty alone
CPAP NIV becomes 1st line Rx for APO along with nitrates and diuretics - many hospitals initially had DIY devices
BiPap devices are marketed and become more widespread after Respironics obtained a patent for bi‑level technology in 1992 after using similar devices from 1988 onwards
early implantable cardioverter‑defibrillator (ICD) expansion: use of ICDs for primary and secondary prevention of sudden cardiac death grew, based on landmark trials in high‑risk patients with low ejection fraction or prior ventricular arrhythmias.
1995: meta-analysis suggested that primary angioplasty had better outcomes than iv thrombolysis for AMI leading to a push for emergent 24×7 “hot” angio facilities
1992-95: several studies confirmed that ACEI's reduced mortality and morbidity when started after AMI, joining the roles of aspirin, betablockers and statins, however, long term antiarrhythmic agents increased mortality in general.
1993: GUSTO trial of thrombolytics in AMI showed that accelerated dose tPA PLUS heparin improved survival compared with streptokinase, and the LATE study showed there was benefit even if given after 6-12hrs after onset
1991: Australian court ruling on involuntary passive smoking starts the process of banning smoking indoors at work, public buildings and then in cars
1990: Goto: disc. of endogenous digitalis-like factor