Geoffrey Hartzler, MD, pioneered angioplasty for acute MI despite intense criticism.

The first to perform balloon angioplasty in a patient with acute MI, Geoffrey Hartzler, MD, was a pioneer in interventional cardiology who broadened the reach of the procedure from simple discrete occlusions to complex lesions, such as multivessel disease, chronic total occlusions, and AMI.

In 1980, Hartzler started the angioplasty program at the Mid America Heart Institute in Kansas City, Mo., and subsequently served as cofounder and director of several medical device companies, including Ventritex, Inc. and IntraLuminal Therapeutics, Inc.

Inspired by Gruentzig

Hartzler met Andreas Gruentzig, MD, at a meeting in 1976 where Gruentzig was presenting data on angioplasty in dogs. “I thought it was crazy,” Hartzler recalled. “We had been taught to never put anything in a coronary artery.”

During his first coronary angioplasty at the Mayo Clinic, Hartzler incurred the wrath of the chief of cardiology. “He started to object and I actually hung up the phone,” Hartzler said. During the procedure, Hartzler had problems placing the balloon in the patient’s lesion.

“The cardiology chief was really mad. I said, ‘Just give me 5 more minutes.’” Hartzler got his time, and he finally placed and inflated the balloon.

The conventional wisdom at the time was that only 5% of patients with coronary disease would benefit from angioplasty. But while working in a large cath lab in Kansas City, Hartzler began demonstrating that many more patients could benefit. He performed 55 coronary angioplasties during the last half of 1980, a “huge number for the time,” he said.

During that period, a patient with unstable angina who was scheduled for an angioplasty had an acute MI before the procedure. “Ordinarily, we would have canceled the procedure,” Hartzler said. “But it just seemed to me that if he had an ideal lesion for angioplasty before, why not bring him into the lab and take a look at it?”

Hartzler performed an angioplasty during the infarction, and “the patient’s pain was immediately relieved and the ST segments went back to normal. It was the first time I had ever seen that and perhaps the first time anybody had ever seen anything like that. It was just astounding.”

Considered too aggressive

Word spread and interventional cardiologists began calling on Hartzler to see the films and hear about the case. “This was so profoundly superior to anything that I had ever seen. It was almost immediate, there was no residual lesion, and it didn’t reocclude.”

Hartzler said he received a lot of criticism for performing the procedure. He was called a “cowboy,” and, in fact, he did wear cowboy boots. “People said we were excessively aggressive. But I think the body of the experience was so compelling and the acute results were so good” that his peers finally agreed.

“It took 20 years for angioplasty to become the gold standard for myocardial infarctions. Now it’s al¬most borderline malpractice not to do it,” he said.

“This was so profoundly superior to anything that I had ever seen. It was almost immediate, there was no residual lesion, and it didn’t reocclude.”- Geoffrey Hartzler, MD

“It took 20 years for angioplasty to become the gold standard for myocardial infarctions. Now it’s almost borderline malpractice not to do it.”- Geoffrey Hartzler, MD