A History of EPIC-SEC

EPIC-SEC is founded on the work of Andreas Roland Gruentzig MD (25 June 1939 – 27 October 1985).

In the late 1960s, Gruentzig learned of the angioplasty procedure developed by Charles Dotter, an American, at a lecture in Frankfurt, Germany. Encountering bureaucratic resistance in Germany to his exploration of angioplasty techniques, Gruentzig moved to Switzerland in 1969. Gruentzig's first successful coronary angioplasty treatment on an awake human was performed on 16 September 1977, in Zurich, Switzerland. He expanded a short, about 3 mm, non-branching section of the Left Anterior Descending (LAD) artery (the front branch of the left coronary artery) which supplies the front wall and tip of the heart which had a high grade stenosis, about 80%, of the lumen. Gruentzig presented the results of his first four angioplasty cases at the 1977 American Heart Association (AHA) meeting, which led to widespread acknowledgement of his pioneering work.

The immediate results of this treatment, despite using only a carefully kitchen built catheter (crude by current standards), were quite good. The patient became and remained angina free after this treatment. This initial patient's result was electively rechecked, by angiography at Emory University, on the 10-year anniversary of the initial treatment. The LAD narrowing, after this 10-year timespan, remained almost perfectly expanded. There was minimal residual narrowing, probably less than 10%, as seen in similar angle and multiple different views comparing with photographs of the original, 10 years earlier, before and after results.

The excellent results of this initial and subsequent patients were critical to the rapid development and growing acceptance of the angioplasty treatment option. Gruentzig recognized multiple important issues early: (a) the treatment would not be readily accepted by most physicians, especially bypass surgeons, (b) it could easily lead to bad outcomes without great care in selection of which patients/lesions to treat and of the treating physicians, and (c) it required careful teaching of the technique and its potential difficulties and pitfalls to other physicians, so as to proactively reduce the occurrence of poor results. Understanding these issues and tireless effort on his part are widely recognized in cardiology for being of fundamental importance to the ultimate success of the technique.

By about 1990, lumen stenosis of the coronary arteries was more commonly treated by the angioplasty technique than by coronary artery bypass surgery. This treatment approach is now referred to as plain old balloon angioplasty (POBA).

In the 1990s, further major improvements, both immediate and especially long term became possible with better understanding of disease as a result of clinical research trials using IVUS and the development of stents to mechanically support POBA results.

Since the later 1990s, most angioplasties also involve a stent over the angioplasty balloon; the balloon is hydraulically expanded, typically at 6–25 atmospheres of internal pressure, then deflated and removed while the stent remains behind to mechanically support the lumen remaining in the new, more open shape as created by the hydraulically expanded balloon.

Gruentzig's success remains a major breakthrough and great contribution to the field of medicine in demonstrating that doctors could work inside of the arteries safely, without the need for open surgery. By utilizing the arterial circulation as a "therapeutic highway", many types of devices and drugs can now be delivered directly to the heart, kidneys, carotid arteries, brain, legs and aorta without the need for major surgery and general anesthesia.

During his time with Emory University, Gruentzig began teaching Angioplasty to his fellow Cardiologists, along with Emory’s John Douglas Jr. MD and Spencer King III MD. The three pioneered the educational conference that would become the Emory Practical Intervention Course (EPIC). EPIC is now the longest running event for Angioplasty in the world.  In 2015, the directors of EPIC decided to expand outside of Emory University by inviting other academic institutions to join in the directing and overseeing of the annual educational conference, creating a Southeastern Consortium (SEC). The rebranded EPIC-SEC conference saw a huge increase in attendance as well as in the caliber of faculty, as it was drawing from a larger pool of talent.

There are now 25 institutions in the EPIC-SEC, driving the educational content of the teaching course, and collaborating on research projects throughout the year.

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