www.scai.org
March/April 2007
The Society for Cardiovascular Angiography and Interventions
SCAI Weighs in on PCI Without On-Site Surgery; Focus Is on Quality Standards
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n early February, SCAI released to widespread international support an expert consensus document examining the current and future role of percutaneous coronary intervention (PCI) without on-site cardiac surgical backup, a report first commissioned in 2004. Then, as now, two words have consistently characterized the project—quality and controversy. “As the society representing the majority of interventional cardiologists in the United States, we felt it was our responsibility to conduct an objective evaluation of an Gregory J. Dehmer, increasingly common practice and M.D., FSCAI offer recommendations to ensure compliance with stringent quality standards,” said Gregory J. Dehmer, M.D., FSCAI, chair of the expert panel and SCAI’s president. Though a focus on quality has fueled the project, controversy was its spark. Controversy surrounds the practice of PCI without cardiac surgical backup,
despite its being successfully performed in leading medical institutions throughout the world. Some may interpret the just-released report as a veiled approval of PCI without on-site surgery and a contradiction of established ACC/AHA/SCAI practice guidelines. However, this is not the intent of the document, Dr. Dehmer noted. “The consensus document is not an open endorsement of PCI without on-site surgical backup. Instead, we are acknowledging that it is being performed well at many facilities and offer our expert opinion on how such programs should be organized, supervised, and performed,” Dr. Dehmer said. “The goal is to improve the quality of coronary interventional care worldwide.” Indeed, the consensus document included authors from several countries and has been endorsed by 12 international societies representing interventional cardiologists around the world (see sidebar on p. 2). The expert consensus document was unveiled (continued on page 2)
CT UPDATE
Tradition Continues
SCAI Offers Hands-on Training to Help Interventionalists With Cardiac Multidetector CT Angiography Certification Requirements
Judkins Cardiac Imaging Symposium to Kick Off Annual Scientific Sessions
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n response to feedback from members as well as forthcoming increases in the training and competency standards recommended by SCAI and other specialty societies, SCAI has greatly expanded its offering of the popular Cardiac CT: Learning by the Cases course. Between now and January 2008, the Society will hold the (continued on page 12)
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CAI co-founder Melvin P. Judkins, M.D., FSCAI, probably wouldn’t be surprised, but he would be delighted to see how the symposium that bears his name has changed over the years, according to Warren K. Laskey, M.D., FSCAI. “The Judkins Cardiac Imaging Symposium anchors us to our past,” explained Dr. Laskey, a former President of SCAI who has chaired the event for 10 of its close to 20 years of existence. “But it really has evolved since the time when we did nothing but x-ray angiography. Now there’s just so much other imaging (continued on page 3)
PCI-Surgical Backup (continued from page 1) and publicized at a major telebriefing hosted by Dr. Dehmer on Feb. 5. Growing Trend There is no question that the practice of PCI without on-site surgery is becoming increasingly common. As of February 2007, primary PCI programs without on-site surgical backup were operating in 40 states. Both primary and elective PCI were being performed without on-site surgery in 27 states. Between 2001 and 2004, 39 facilities without on-site cardiac surgery submitted PCI data to the ACC-National Cardiovascular Data Registry (ACC-NCDRTM), a number that climbed to 75 in 2005. International data from 39 countries responding to SCAI’s request for information indicate that PCI is performed without on-site surgical backup in 90 percent of these countries. Critics say that, at least in the United States, the trend is fueled by financial motives and worry that quality is being placed on a back burner. Supporters counter that patients who live in remote or economically deprived areas benefit when PCI is available in their local communities. One thing is certain, emergency coronary artery bypass graft (CABG) surgery is necessary far less often today than in the past. In the early days of balloon angioplasty, 1.0 percent to 2.5 percent of patients died and 1.9 percent to 5.8 percent required urgent CABG surgery. Today, high-volume centers report an in-lab mortality rate of about 1–2 per 1000, and a 0.3 percent to 0.6 percent incidence of urgent CABG surgery. Perhaps the strongest argument in favor of PCI in hospitals without cardiac surgery programs is the need to rapidly treat patients experiencing an acute myocardial infarction (MI). Restoration of coronary blood flow within the target 90 minutes becomes more challenging if the patient requires transfer to a PCI center with cardiac surgery. As a result, primary PCI at nonsurgical hospitals is common—and was designated a Class IIb indication in the 2005 revision of ACC/ AHA/SCAI PCI guidelines. The 2005 PCI guidelines recommend against elective PCI in nonsurgical centers, however, rating it a Class III indication, as did the 2001 set of guidelines. Nonetheless, many hospitals performing primary PCI without surgical backup have launched elective PCI programs. One key reason: the difficulty of maintaining high-quality facilities and highly skilled nurses, technicians, and physicians in a program that treats only a small number of patients with MI each month. “The problem is that there are many fewer MI patients than there are patients needing elective proce-
International Support for SCAI’s Consensus Document As of February 2007, the following medical societies have endorsed SCAI’s expert consensus document on PCI without on-site surgical backup:
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Asian Pacific Society of Interventional Cardiology Belgian Working Group of Interventional Cardiology Brazilian Society for Interventional Cardiology British Cardiovascular Intervention Society Working Group on Interventional Cardiology of the Bulgarian Cardiology Society Cardiac Society of Australia and New Zealand Egyptian Society of Cardiology Working Group on Interventional Cardiology Interventional Council of the Cardiological Society of India Italian Society of Interventional Cardiology Latvian Society of Cardiology Polish Working Group on Interventional Cardiology of the Polish Cardiology Society Sociedad Venezolana de Cardiología Intervencionista (Venezuelan Society of Interventional Cardiology)
dures,” Dr. Dehmer said. “It becomes very hard to sustain a program with primary PCI alone.”
Recommendations The SCAI consensus document recommends that PCI programs operating without on-site cardiac surgery— • Maintain case volumes of at least 200 PCIs per year for the facility; • Employ highly skilled interventional cardiologists who have performed more than 500 PCIs throughSCAI News & Highlights is published bimonthly by The Society for Cardiovascular Angiography and Interventions 2400 N Street, NW, Washington, DC 20037 Phone 800-992-7224; Fax 202-375-6837 www.scai.org; info@scai.org Gregory J. Dehmer, M.D., FSCAI President Morton Kern, M.D., FSCAI Editor-in-Chief Kathy Boyd David Managing Editor Rick Henegar Director, Membership and Meetings
Wayne Powell Senior Director, Advocacy and Guidelines Bea Reyes Director, Education
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out their career (or are mentored by an experienced interventionalist), who have a personal annual case volume of at least 100 PCIs including ≥ 18 primary PCIs per year, and meet national benchmarks for procedural success and complication rates; Train all support personnel in the management of PCI patients; Establish an on-call schedule that supports operation of the laboratory 24 hours a day, 365 days a year; Select patients and lesions carefully to control the risk of complications; Establish a close alliance with cardiovascular surgeons, including formalized and tested protocols for emergency transfer of patients; Activate emergency transport at the first clear signs of a PCI complication, thereby ensuring that the time to the initiation of cardiopulmonary bypass does not exceed 120 minutes; and Collect appropriate outcomes data and submit them for comparison with state or national
performance standards. The message behind the consensus document is PCI quality, whether the procedure is performed in hospitals with cardiac surgical backup or without. “Ensuring that all PCI programs meet appropriate performance metrics is likely to save more lives than requiring all PCI programs to have on-site surgery,” Dr. Dehmer said. The first data from a large randomized controlled trial on PCI without cardiac surgical back-up is expected sometime in 2008, when the Atlantic Cardiovascular Patient Outcomes Research Team (CPORT) will report its findings. The executive summary of the expert consensus document, as well as a President’s Page editorial by Dr. Dehmer, is published in the March 2007 issue of Catheterization and Cardiovascular Interventions. These documents, plus the full text of the document, can be found at www.scai.org. n
Judkins Symposium (continued from page 1) technology that’s being brought to the discipline.” The full-day event, which will take place Wednesday, May 9, kicks off SCAI’s 30th Annual Scientific Sessions in Orlando, FL. What’s unique about the Judkins Symposium is its comprehensive mix of both fundamentals and innovations, stressed Dr. Laskey. “My goal has always been to provide a mix of old and new,” he continued. “It’s a mix of the basic stuff people need to know about the myriad of imaging modalities as well as the practical stuff.” The morning will be devoted to what Dr. Laskey calls the “core curriculum,” an overview of variWarren K. Laskey, M.D., ous imaging technologies. ChanFSCAI dra Sehgal, Ph.D., of the Hospital of the University of Pennsylvania, for example, will discuss the physics of ultrasound. Jenss Schmidt-May, Ph.D., of Philips Medical Systems in Hamburg, Germany, whom Dr. Laskey calls “probably the smartest person in the world about xray tubes,” will give a talk called, “Advances in Xray Tube Technology: Angiography and MDCT.” Other presentations will include “Digital Fluoroscopy and Fluorography: A to Z,” “Flat Panel Technology: What Does the Clinician Need to Know?”, “Physics of MRI: Teslas, Hz and Resolution,” and “Physics of X-radiation.” “The morning speakers are more of the academic people who are highly regarded in the scientific
realm,” explained Dr. Laskey. “These sessions are for people who want to get the didactic aspects.” In the afternoon, the attention will shift to creative clinical applications of the scientific information presented in the morning sessions. “The afternoon is more free-wheeling,” said Dr. Laskey. “The speakers are people who are well-known in the clinical community explaining how to use this information in real life.” Neil J. Weissman, M.D., of Georgetown University, for example, will discuss the use of ultrasound in the cath lab. Robert L. Wilensky, M.D., of the University of Pennsylvania, will tackle the topic of MRI. And John C. Messenger, M.D., of the University of Colorado, will handle CT. “Dr. Messenger’s lab is pushing the envelope when it comes to what you can do with this technology in the cath lab,” noted Dr. Laskey. Other afternoon presentations will include “Radiation Safety: Practical Applications in the Cath Lab,” “Radiographic Contrast Media: Always Something New,” and “Electro-Mechanical Imaging Modalities: Dead or Alive?” And, Dr. Laskey emphasized, the symposium doesn’t just cover imaging itself; it will also feature an important talk about policy developments affecting imaging. Former American College of Cardiology President Pamela S. Douglas, M.D., of Duke University, will give a talk called “The Practicing Cardiologist and Imaging Technology.” “The move toward credentialing and competence (continued on page 7)
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SCAI’s Hemodynamics Symposium Offers Rare Chance to Learn, or Re-learn, Fundamentals
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ast year, Zoltan G. Turi, M.D., FSCAI, was believe he was alone in needing such a course.” hoping for about 100 attendees at SCAI’s inIn conversations with several SCAI Past Presiaugural Hemodynamics Symposium in Chi- dents, he heard echoes of his own concerns about cago. Although he knew there was a very real need the lack of training today’s fellows receive in hemofor a course that addressed the subtleties of hemody- dynamics. “When I was a fellow 25 years ago, we namics and angiography, he still questioned his own spent the first two years analyzing the subtleties of math skills when he counted 266 physicians vying for pressure tracings. Now our fellows rely entirely on seats in the crowded room. And, nine hours after he the computer for this, and there is an alarming tenopened the one-day symposium, dency for them to parrot whatever the computer people were still standing in the says, even if the data make no sense,” said Dr. Turi. back, eager for more of this course’s To help today’s interventionalists get back in unique focus on the fundamentals touch with the basics of their profession, Drs. Turi of diagnostic catheterization. and Kern have assembled “a faculty of some of the This year, SCAI has, of course, most dedicated teachers in invasive cardiology,” reserved a much bigger room for he said. “This is a labor of love because it’s not the the Hemodynamics Symposium, glamorous stuff. What it is, is the essential stuff.” which will be held Wednesday, Included in that all-important “stuff” are many Zoltan G. Turi, M.D., FSCAI May 9, in Orlando, FL, again as real-world examples that will fool physicians who part of the Society’s Annual Sci- aren’t careful, possibly leading them to make decientific Sessions. The 2006 Hemodynamics Sympo- sions that could even harm patients. “Our purpose sium received high praise in the course evaluations, is not to trick the audience but to show them how with many attendees commenting on the dearth of to differentiate pathology from artifact,” Dr. Turi continuing medical education (CME) programs on explained. “They’ll see severe disease and data that material so basic to the practice of invasive/inter- only look like severe disease; data from patients who ventional cardiology. need immediate inter“We shouldn’t have vention versus data from “. . .This course was conceived been so surprised by the patients who really need because there is almost nothing tremendous attendance. medical care only.” available in the United States After all, this course was To keep the program for physicians who want to reacquaint fast-paced conceived because there and fun, the themselves with the building blocks is almost nothing availsymposium is packed of our profession or for fellows who able in the United States with relatively short talks for physicians who want as well as mini-quizzes realize they are relying too much to reacquaint themselves and use of an audienceon what the computer tells them with the building blocks and too little on their own knowledge response system that of our profession or for helps attendees with selfof hemodynamics.” fellows who realize they assessment. –Dr. Turi are relying too much on In addition to getting what the computer tells reacquainted with the them and too little on their own knowledge of hemody- intricacies of hemodynamics, coronary and periphnamics,” said Dr. Turi, who chairs SCAI’s Hemodynam- eral angiography, and structural heart disease, they’ll ics Symposium with Morton J. Kern, M.D., FSCAI. also acquire something else that’s very important in Dr. Turi tells of a shocking day almost a decade ago the interventionalist’s armamentarium, stressed Dr. when he was asked to recommend a CME course in di- Turi. “They’ll acquire much more confidence in their agnostic catheterization for a colleague who had expe- decision making and improve their ability to leave rienced a near-disaster in the cath lab. “I was stunned the cath lab with a definitive diagnosis. That’s very to see that there was no longer a single program in helpful in deciding whether or not to intervene.” the United States that taught the fundamentals of For more information or to register for SCAI’s diagnostic catheterization. That was precisely what 30th Annual Scientific Sessions, call 800-992-7224 this seasoned cardiologist needed. I simply couldn’t or visit www.scai.org. n
SCAI Brings Strategies for Success to Scientific Sessions
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CAI is pleased to offer attendees of the 30th Case Studies From the Office of the Inspector GenerScientific Sessions in Orlando, FL, unique ac- al and the Department of Justice.” Featured speakers cess to the long-running and highly regarded will include attorney Alice G. Gosfield; Lew Morris, Strategies for Success program. Christopher U. Esq., Chief Counsel to the Inspector General; and Cates, M.D., FSCAI, who founded the program in Jim Sheehan, Esq., Chief Prosecutor of the Civil Dithe early 1990s, has developed a half-day Highlights vision of the U.S. Department of Justice. of Strategies mini-course that will give SCAI ’07 atThe mini-course will also feature a practical, nutstendees a taste of Strategies’ signa- and-bolts session on compensation and partnership ture focus on controversial topics models for cardiovascular practice. Ron Riner, M.D., and the high-profile speakers it President of The Riner Group, Inc., will lead this gathers to tackle them. open discussion related to declining physician reim“The full Strategies course runs bursement and pressures placed on physician income over a three-day period and the distribution in practices. Also discussed will be varipresentations are in-depth, with ous partnership track models for practices and the pros plenty of interaction between and cons for the different compensation models. Christopher Cates, M.D., speakers who are the decision“I’m very excited about this FSCAI makers in health care, and our at- opportunity to bring Stratetendees,” explained Dr. Cates. “For gies for Success into the conthe purposes of the Highlights course, we’re compress- text of a national medical ing the talks and reducing the question-and-answer meeting,” said Dr. Cates. periods a bit, but we’re sticking “I’m very excited to the Strategies about this opportunity formula–which to bring Strategies for Success is bringing cardiinto the context ologists together of a national medical meeting. with the people who make the It’s important, in the midst of policy decisions a lot of information about in health care.” new technologies and clinical issues, The Highlights to take some time to address of Strategies course the macro issues in health care. will be held FriStrategies offers a very rare opportunity day, May 11, from 2:45 to 5:30 p.m. to do just that.” Joining Dr. Cates –Dr. Cates at the moderators’ table will be Gail R. Wilensky, Ph.D., who headed up the Centers for “It’s important, in the midst Medicare and Medicaid Services when it was known of a lot of information about as the Health Care Financing Administration, or new technologies and cliniHCFA. “Dr. Wilensky now advises Congress and the cal issues, to take some time Bush administration on health care issues, so she is to address the macro issues in health care. Strategies going to kick off the lectures with a discussion of one offers a very rare opportunity to do just that.” of the biggest advocacy issues throughout the House of For more information or to register for the SciMedicine – Medicare and physician reimbursement, entific Sessions, visit www.scai.org or call 800-992specifically what we should expect from the current 7224. Watch for details on Strategies for Success Congress,” said Dr. Cates. XVI in June 2008 in the Grand Cayman Islands. n Following Dr. Wilensky’s presentation will be a panel discussion titled, “Regulatory Fraud and Abuse:
Training Directors’ Symposium – Forum for Dialogue With Decision-Makers
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or the third consecutive year, SCAI will host the annual gathering of interventional cardiology training directors. The symposium – to be held Wednesday, May 9, 2007, during SCAI’s Annual Scientific Sessions in Orlando, FL – will again bring onto one stage representatives from “the agencies that make the rules training directors must play by,” said Joseph D. Babb, M.D., FSCAI, who has moderated the Interventional Cardiology Training Directors’ Symposium since it found its home with SCAI. Along with Dr. Babb, Mark Reisman, M.D., FSCAI, chair of SCAI’s Training Program Standards Committee, will be a key participant in the 2007 symposium. Approximately 70 training diJoseph Babb, M.D., rectors attended last year’s sympoFSCAI sium, with many taking advantage of the unique opportunity the meeting presents to engage in direct dialogue with representatives from the Accreditation Council for Graduate Medical Education (ACGME), Residency Review Committee (RRC), American Board of Internal Medicine (ABIM), and Educational Commission for Foreign Medical Graduates (ECFMG). “The fact that representatives from all of these agencies were so willing to come to the SCAI meeting and to engage in dialogue with us speaks to SCAI’s position as the spokes-organization for interventional cardiology,” said Dr. Babb. “It also underscores how important it is that the training directors in interventional cardiology attend the meeting each year and actively participate.” Such active participation is what the meeting is all about, said Dr. Babb. “By coming to our meeting, these agencies that regulate our training programs and set the standards for us are inviting us to provide them with input and guidance. That’s huge for us as training directors. It empowers us to frame the issues facing our fellows, format the tough questions that need to be asked, and give them meaningful feedback.”
Some of the tough questions Dr. Babb mentions were posed last year, and he expects many to be revisited in Orlando, especially since the 2007 agenda will also include presentations from two interventional cardiology training directors who have recently experienced a site visit. “It’s going to be interesting to examine their experiences like case studies and then turn to the officials who make such visits and ask questions,” said Dr. Babb. “I am hopeful that doing so will move us toward some changes because ACGME, for example, has said repeatedly that it will respond to the will of the training directors. In other words, if we say, this is what we must have to competently training our fellows, then that is what ACGME will do.” “As examples,” continued Dr. Babb, “we have to help ACGME get to a good resolution on questions like, how do we fit in training for peripheral vascular disease interventions, and why are we requiring fellows in a one-year program to spend one-half day in clinic when they’ve already experienced and understand continuity of care from their internal medicine and cardiology training programs.” That such questions are being welcomed by the standard-setters on training programs means that they are open to suggestions for changes, perhaps even dramatic ones about dropping duplicative requirements to make more time for activities related to new technologies, explained Dr. Babb. He is looking forward to a discussion about whether interventional cardiology programs have matured to the point that participation in a match process would benefit both programs and applicants. He continues to be encouraged by quick acceptances he receives from speakers such as Laura Wexler, M.D., of the ABIM; Rosemarie Fisher, M.D., of ACGME; and Henry Schultz, M.D., of the National Resident Matching Program. “That these people want to talk to us means that we training directors don’t have to sit on the sidelines and be unhappy about decisions made by the agencies, nor do we have to go home buried in a mass of mumbojumbo because there’s a forum for direct interaction, and it’s at SCAI’s Scientific Sessions.” n
Judkins Symposium (continued from page 3) and proficiency is extremely timely and relevant,” said Dr. Laskey, noting that Dr. Douglas has been very active in developing criteria for deciding what kind of imaging tests to order, how to evaluate their appropriateness, and how to assess the competence of the person doing the testing. Of course, it’s impossible to cover everything in a
single day, which is why Dr. Laskey encourages attendees to come every year. “Over the course of two, three, four years, repeat attendees do get the full dose,” he explained, adding that the number of participants grows each year. “And I don’t get the same speakers year after year, so there are always new people and new topics.” To learn more or to register for the Annual Scientific Sessions, visit www.scai.org. n
SCAI President Discusses Stents at New York Times Foundation Journalism Institute
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t the highly regarded New York Times Foundation – Markle Foundation Journalism Institute held in February, SCAI President Gregory J. Dehmer, M.D., FSCAI, spoke to an audience of approximately 30 medical journalists about the evolving use of drug-eluting stents in health care. His presentation, a joint effort with Rita Redberg, M.D., a cardiologist from the University of California–San Francisco, was one of two case studies presented in a larger discussion about health care technology, costs, and policy. Drs. Dehmer and Redberg were among a handful of distinguished physicians invited to participate in the educational forum. Their talks, together titled “Stinting on Stents: How Payment for New Technology Gets Wired,” followed lectures by health policy experts Stuart Altman, Ph.D., Medical journalists from throughout the United States attended the Institute, where SCAI President Herb Pardes, M.D., and Dr. Gregory J. Dehmer discussed how new techEmma Deland about the nologies affect hotly debated issues in health care. role of hospitals in heavily
debated issues such as access to care, quality, and costs. Other case studies focused on cancer, diabetes, and the medical management of cardiovascular disease. “The purpose of the four-day institute was to enlighten journalists from all over the United States about some of the more challenging issues facing health care in this country, so that the stories they write, and that our patients read, will be more informed and insightful,” explained Dr. Dehmer. “Dr. Redberg and I were specifically asked to help the journalists understand the clinical and economic decision-making criteria that must be considered when new technologies, such as drug-eluting stents, enter the medical environment and to discuss the challenges we face in making sure that such important, but also expensive, devices are used appropriately. “Overall, this was an interesting and valuable experience in that it provided a perspective on how journalists process scientific information and develop their stories,” said Dr. Dehmer. “There was tremendous interest in the topic of drug-eluting stents since this followed, by just a few months, the Food and Drug Administration’s Advisory Panel hearings. And I was pleased that there were journalists interested in learning more about SCAI as the professional society representing invasive and interventional cardiologists.” n
SCAI Members On The Move Have you moved or changed positions recently? Do you know anyone who has? Drop us a note, and we’ll let your colleagues know. That’s the purpose of “Members on the Move,” our periodic column that spreads the word about members’ activities and accomplishments. “Members on the Move” shines the spotlight on members with new titles, new affiliations, new practices, …. Send your news to info@scai.org After nearly 12 years as the Chief of Cardiology at the University of Texas Medical Branch in Galveston, SCAI Immediate Past President Barry F. Uretsky, M.D., FSCAI, has embarked on a new challenge. In early February, he and his wife, Sandy, moved to the foothills of the Ozark Moun-
tains in Arkansas, where he will be the Medical Director of Cardiology and Cardiovascular Services for Barry F. Uretsky, the Sparks Health M.D., FSCAI System. The new position has him wearing many hats, including Director of Cardiology of the system’s multispecialty group and Medical Director of Cardiovascular Services for the affiliated hospital. He will also oversee the development of a center for cardiovascular research, bringing the Sparks Medical Foundation’s several clinical research programs together under one roof. Serving the population of Fort
Smith, AR, which numbers about 80,000, plus a cachement area of approximately 350,000, the health system is poised for growth, said Dr. Uretsky. “I see a strong possibility for developing a first-class cardiology program, complete with high-quality clinical services as well as educational opportunities and research advances,” he said. “Our program is growing, and we’re looking for highly qualified cardiologists who specialize in the interventional, noninvasive, and electrophysiology areas.” Dr. Uretsky urges interested SCAI members or their colleagues to contact him at buretsky@sparks.org S Bringing interventional cardiology to rural southern Ohio
is an exciting experience for Heather Horton, M.D., Ph.D., FSCAI. After five years of work at a larger hospital in Pennsylvania, Dr. Horton came to Southern Ohio Medical Center (SOMC) in Portsmouth in September to build an interventional program. “It’s always rewarding to be able to bring life-saving measures to a community where people had to travel one to two hours to larger metropolitan hospitals for coronary angioplasty,” she said. “There is no shortage of cases and the need is just as great, if not greater, here in the MidHeather Horton, west as in other parts M.D., Ph.D., FSCAI of the country. We have been seeing two to four primary angioplasty cases per week.” SOMC has launched a $100 million expansion of facilities and programs with heart and vascular services as the core. “This has been exceptionally exciting because we’re the only facility to serve more than 120,000 people in the surrounding area. We have the commitment of the hospital to bring these services to the community, and we know that we’re saving lives,” she said. Dr. Horton is a board-certified interventional cardiologist who has been in practice 10 years. She came to SOMC from a position as the director of the Cardiac Cath Lab at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, PA. S After eight years in private practice, R. David Anderson, M.D., M.S., has joined the University of Florida Health Science Center, where he is the Director of Interventional Cardiology and an Associate Professor of Medicine. “Since completing my fellowship and interventional training at Duke, I’ve had the desire to return to teaching and an academic
setting, so this was an opportunity I couldn’t pass up,” said Dr. Anderson. “My charge is to teach the fellows R. David Anderson, cardiac catheterM.D., M.S. ization as well as percutaneous intervention, which complements my experience in multiple trials of angiogenesis and peripheral arterial disease.” Also on the horizon for Dr. Anderson is becoming involved with the percutaneous treatment of PFOs and ASDs, launching a percutaneous valve replacement program, and bringing new research protocols to the University of Florida. “And, of course, I want to get back into writing and publishing as soon as possible,” he noted. S Richard Stewart, M.D., FSCAI, wrote to SCAI about his recent move to Fort Worth, TX, where he is Associate Professor of Medicine/Cardiology and Director of Endovascular Interventional Medicine at the University of North Texas Health Science Center as well as Director of the cardiac catheterization laboratory at Richard Stewart, John Peter Smith M.D., FSCAI Hospital. Dr. Stewart is enjoying being back at an academic medical center. S In January, Caritas St. Elizabeth’s Medical Center, Caritas Carney Hospital, and Caritas Christi Health Care announced the appointment of Jeffrey J. Popma, M.D., FSCAI, as their new Director of Invasive Cardiovascular Services. Dr. Popma, a Past President of SCAI, will coordinate and standardize highquality and integrated invasive cardiovascular services within the Caritas network in collabo-
ration with the catheterization laboratory directors at five community hospitals. “I am humbled by the opportunity to work with our community hospital physician partners in developing standardized, evidence-based interventional cardiovascular care for our patients,” said Dr. Popma. “Education and training are critical components of this effort.” He will be the overall director of the Consolidated Cardiac Catheterization Laboratories, which, he said, will require “embracing the fundamentals – developing close Jeffrey J. Popma, physician relation- M.D., FSCAI ships within the communities we serve; facilitating access to our hospitals for referring physicians, patients, and their families; and providing tertiary cardiovascular support for our community hospitals.” Dr. Popma will also serve as the director of the Caritas Center for Advanced Cardiovascular Education and Training, a facility dedicated to training in advanced cardiovascular techniques for interventional cardiologists, vascular, and cardiovascular surgeons. “At the end of the day, it is all about patient safety,” he said. “Evidence-based procedural protocols and state-of-the-art simulation training will be essential features of this advanced cardiovascular training effort.” n
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SCAI Delivers Practical Guidance on Use of DES
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n the month following advisory panel hearings held • Patients should take dual-antiplatelet medicaby the Food and Drug Administration on the safety tions for at least three to six months, preferably of drug-eluting stents (DES), SCAI moved swiftly to for 12 months unless there is a high risk for deliver specific and practical recommendations on the bleeding. In patients with a higher-than-average best use of these devices in the care of patients with risk for late stent thrombosis—for example, those cardiovascular disease. Leading the effort to draft and with diabetes—physicians should consider not distribute the Society’s Clinical Alert was SCAI Past only continuing dual-antiplatelet medications for President and DES Writing Committee Chair John longer than 12 months, but also testing responMcB. Hodgson, M.D., FSCAI. The Clinical Alert siveness to these medications and adjusting doswas approved by SCAI’s Executive Committee and ages as needed. rapidly moved into the hands of Catheterization and • Discontinuation of dual-antiplatelet medicaCardiovascular Interventions Editor-in-Chief Christotions requires careful consideration and must be pher J. White, M.D., FSCAI. individualized for each patient. “To our knowledge, SCAI was the first professional A week after the distribution of SCAI’s Clinical medical society to publish a CliniAlert, Dr. Hodgson found himself “Do a good job, do it addressing questions related to cal Alert on DES following the in the right people, FDA hearings,” said Dr. Hodgson, these latter points about the imwho was interviewed by several reportance of antiplatelet therapies be sure you look porters and quoted by mainstream for DES patients. The interest folat the whole package, media outlets such as U.S. News and assess the risks and lowed from the release of a state& World Report, the Associated ment by the American Heart AssoPress, and The Washington Post, as benefits before you do it.” ciation (AHA) and various other -Dr. Hodgson well as many health care-focused medical societies, including SCAI. outlets, such as theheart.org, Cath Lab Digest, and HealthDay, among many others. In Talking With Third-Party Insurers, Too interviews, Dr. Hodgson stressed the importance of At press time, Dr. Hodgson was preparing to testify a “back-to-basics” approach in the use of DES, not- before the California Technology Assessment Forum, ing that new data revealing the rare but undeniably an advisory organization for the Blue Cross/Blue Shield. serious occurrence of late-stent thrombosis in a small He has been asked to testify on the safety of DES. group of DES patients should remind interventional“My goal is to clear up the confusion surrounding ists to “Do a good job, do it in the right people, be the safety of the devices,” he explained. “It’s imporsure you look at the whole package, and assess the tant that insurers understand that there are risks and risks and benefits before you do it.” benefits with all therapies, and drug-eluting stents The practical steps outlined in the Society’s DES are not an exception. However, when they are used Clinical Alert include the following: properly, in the right patients, and with the proper • Prior to any stent implantation, patients should follow-up medications, as outlined in SCAI’s Clinimeet accepted criteria for coronary intervention cal Alert, they do a lot of good for a lot of patients as described in the 2005 update of the ACC/ with cardiovascular disease.” AHA/SCAI practice guidelines on percutaneous SCAI will keep members informed as issues recoronary intervention. lated to DES unfold. Visit www.scai.org often for • The decision to treat a patient with DES —rath- updates. The Web site also features SCAI’s Clinier than a bare metal stent or bypass surgery— cal Alert on DES, the AHA-spearheaded consenmust be made on an individual patient basis, sus document on antiplatelet medications, and Dr. considering the relative risks and benefits of each Hodgson’s testimony. n therapy. This determination will vary according to each patient’s medical history, coexisting illnesses, and lesion characteristics. • Patients must be carefully evaluated for their ability to adhere to long-term therapy with dual antiplatelet medications. • Careful attention must be paid to stent implantation technique.
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CT Update (continued from page 1) program five times in four cities, including a special oneday mini-course held in conjunction with the 30th Annual Scientific Sessions in Orlando, FL. The other sites are Phoenix, AZ (April 2–3, 2007, and Jan. 10–11, 2008), San Francisco, CA (June 18–19, 2007), and Minneapolis, MN (Sept. 10–11, 2007). Robert S. Schwartz, M.D., FSCAI, and John McB. Hodgson, M.D., FSCAI, are leading SCAI’s efforts to help interventionalists obtain hands-on, workstation-based training in cardiac CT before July 2008, when the recommended training levels for level-II certification will Robert S. Schwartz, M.D., FSCAI increase. After that deadline, the only way to meet the recommended training standards will be through an accredited fellowship program. “We want to provide ample opportunities for our interventional colleagues to learn this new important new technology and be very comfortable with it before that deadline arrives,” stressed Dr. Hodgson, who will co-chair four of the five courses with Dr. Schwartz. “Cardiac CT John McB. Hodgson, M.D., FSCAI is a pivotal technology that is going to change the whole landscape of how we treat patients with coronary artery disease. Dr. Schwartz and I firmly believe that the Society should play a key role in the training of physicians in the interpretation of cardiac CT.” SCAI has accepted its responsibility to be a leader in cardiac CT education by delivering precisely the type of educational experience cardiologists need to achieve proficiency in this new technology, said Dr. Schwartz. “We have spent our careers focusing on the coronary arteries, so there’s no need to spend time reviewing anatomy. What cardiologists need to become skilled at cardiac CT is time with their hands on the workstations, practicing case after case and doing the analysis first-hand.” Delivering case after case is what sets SCAI’s aptly
named Learning by the Cases program apart from the majority of programs currently being offered. The other courses tend to focus on didactic instruction, with a limited amount of hands-on experience reformatting two-dimensional axial CT slices into three- and fourdimensional renderings of the heart and blood vessels. “With the exception of the one-day mini-course we’ll be holding in Orlando, all of our courses guarantee that every attendee will work on at least 50 cases, and they will share their assigned workstation with only one other attendee,” said Dr. Schwartz. “This is a very intense course because the focus is on teaching each attendee how to use the buttons on the workstation to rotate, flip, shade, color-code, and reformat images into as many new views as they need to feel very comfortable on their own, interpreting their own studies and manipulating images to get the correct answers,” said Dr. Hodgson. The Learning by the Cases faculty have developed a diverse set of cases for attendees, enabling the individual programs to be tailored to the skill levels of the physicians. In addition, each workstation room is monitored by an experienced “mentor,” who provides personalized instruction as well as “pearls of wisdom” for the whole class. “Part of our vision is to have great cardiology cases—to provide a very rich case selection and to show how CT is ideally suited to diagnose and demonstrate a wide variety of pathologies and a wide variety of cardiac problems,” said Dr. Schwartz. “Plus, most of the 350–400 physicians we’ve trained in past courses have found that the digital manipulation and virtual detection are really fun.” For more information or to register for one of SCAI’s scheduled Learning by the Cases programs, visit www. scai.org or call 800-992-7224. So that all attendees get ample time to practice manipulating images and analyzing cases on the workstations, enrollment is limited. Register early to be sure you get a seat! n
THANK YOU
The Society for Cardiovascular Angiography and Interventions expresses deep appreciation to the following companies for the generous in-kind support of educational workstations for the programs: Cardiac CT Angiography–Learning by the Cases April 2 & 3, 2007, Phoenix AZ GE Healthcare Vital Images, Inc. May 12, 2007, Orlando, FL GE Healthcare TeraRecon, Inc. Vital Images, Inc.
June 18 & 19, 2007, San Francisco, CA Vital Images, Inc. September 10 & 11, 2007, Minneapolis, MN TeraRecon, Inc. Vital Images, Inc. January 10 & 11, 2008, Phoenix, AZ TeraRecon, Inc. Vital Images, Inc.
www.scai.org
2006 SCAI Interventional Cardiology Fellows Course November 29 – December 2, 2006 • Las Vegas, NV
THANK YOU
The Society for Cardiovascular Angiography and Interventions expresses deep appreciation for the generous support from the following companies PLATINUM SUPPORTER
Boston Scientific Corporation GOLD SUPPORTERS
Cordis, a Johnson & Johnson company Abbott Vascular/Guidant SILVER SUPPORTERS
St. Jude Medical GE Healthcare Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership Daiichi Sankyo, Inc. and Eli Lilly and Company BRONZE SUPPORTERS SCAI ALSO THANKS: Abbott Vascular for support of the fellows dinner and fellows workshops Boston Scientific Corporation for support of the audience response system, faculty dinner, and fellows workshops Cordis for support of fellows research grants in interventional cardiology GE Healthcare for support of fellows research grants in angiography and diagnostic imaging Mentice for support of the faculty reception
Medtronic Vascular AGA Medical Corporation Cook Inc. Schering-Plough Terumo Interventional Systems W. L. Gore and Associates, Inc. PDL BioPharma
Appreciation is also expressed to the following companies for in-kind support of educational simulators, IVUS, and/or FFR units for the program: Boston Scientific Corporation Cordis Corporation, a Johnson & Johnson company Medical Simulation Corporation Mentice AGA Medical Corporation RADI Medical Systems, Inc. Terumo Interventional Systems Volcano Corporation
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In The Trenches
Former Internal Medicine Physician Finds His Heart in the Cath Lab
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lu season was right around the corner when we caught up with former internal medicine doctor Peter Angelopoulos, M.D., FSCAI. Now an interventional cardiologist, this doctor is quite happy that he no longer thinks about how many colds he will be treating or how much Tylenol he will need to prescribe. Rather, his attention is focused year-round on the patients entering his cath lab, where with one delicate procedure a patient’s life can be changed forever.
he launched a practice in Smithtown, NY; however, after four years, he came to terms with the fact that he wasn’t happy with his career. He closed down his practice and joined the cardiology training program at NYU-Manhattan VA. The critical moment, when Dr. Angelopoulos knew he had found his niche in life, occurred during the first week of his cardiovascular fellowship, shortly after he set foot into the cath lab for the first time. He explained: “I was amazed that you could fix coronary lesions and relieve patients’ chest pains and heart attacks. I felt as if I was finally contributing to something really important. I knew then and there that I was going to become an interventional cardiologist.”
Blood Pressure Check, Anyone? “I always knew I was going to medical school—probably from the time I was in junior high,” explained Dr. SCAI, Always “On Call” Angelopoulos. “I remember learning how to take blood pressures and Dr. Angelopoulos first heard about neighbors coming over to the house SCAI after finishing his interventional It wasn’t long after setting foot in the cath to have their numbers checked.” cardiology fellowship. “Because SCAI lab for the first time that Dr. Angelopoulos His parents, both from Greece, never realized he’d found his niche in life. is smaller than the other cardiovascular had the opportunity to advance their forassociations, you actually feel part of the mal education because they grew up during World War II Society. I can always pick up the phone and talk to someand the civil war that followed in Greece. “My father was one there on any issue, and they will deal with it immedia butcher by trade and worked up to three jobs to provide ately. And, through SCAI, you can also phone or e-mail for our family. My mother stayed at home to raise the any expert in the interventional field with any questions. children,” he said. Both of his parents were firm believers I am also thankful to SCAI—and in particular Dr. Chris in the value of education, and they instilled this belief in White—for helping members get reimbursement and their children, but the realities of paying for such instruc- training for peripheral interventions.” tion posed tough challenges. Dr. Angelopoulos has recently become involved The cost of higher education became apparent when in the SCAI Interventional Career Development Dr. Angelopoulos was accepted into New York Univer- Committee and looks forward to finding ways to sity’s pre-med program. “Recognizing the cost, I dropped help the Society grow. out before starting. I knew my parents could never afford it,” he said. Instead, he turned to Queens College, part of “That Wonderful Rush” the City University of New York, where he was able to Dr. Angelopoulos is currently busy as part of a group work, first as a bank teller and later as an EMT and para- practice in Garden City, NY. He enjoys the day-to-day life medic, to pay for his undergraduate schooling. of an interventionalist and is known for his bedside manner: he keeps his patients smiling with a steady stream of Finding His Niche light-hearted banter. However, for him, it all comes down Dr. Angelopoulos’s paramedics instructor encouraged to what he can accomplish in the cath lab. “There is no him to go to Ross University in Dominica, West Indies, greater rush than opening a totally occluded artery and for medical school. It was excellent advice, said Dr. within minutes seeing it wide-open with excellent flow. Angelopoulos, for more reasons than one might guess. And the patient actually feels good enough to go home!” There he met Gina, an emergency medicine physician- he exclaimed. “Or, as another example, when a patient in-training, whom he later married. comes for a checkup—after I have opened her iliac arterAfter completing his internal medicine residency, ies—and she tells me she can now outwalk her dog.” n