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March/April 2009

The Society for Cardiovascular Angiography and Interventions

Get Back to Basics at SCAI’s Hemodynamics Symposium

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New Sessions at SCAI 2009 Offer Practical Help on Recertification and More

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f interventional cardiologists are feeling a bit overwhelmed these days, it’s understandable. Not only are new clinical trial data being published at every turn, but thousands face looming deadlines to complete complex requirements for recertification in Interventional Cardiology. Not to worry. Attendees will find plenty of help at the 2009 SCAI Annual Scientific Sessions in Las Vegas in May. Several new sessions debuting this year have been designed with very practical goals in mind. One set of sessions will offer hands-on help with fulfilling recertification requirements. The other set of sessions is designed to rope together recent clinical trial data in key subject areas and make sense of it all, allowing attendees to come away with useful information that changes clinical practice. “The broad theme of our meeting for several years has been ‘The Best of the Best,’” says Ted Feldman, M.D., FSCAI, program chair of the 2009 Annual Scientific Sessions and director of the cardiac catheterization laboratory at Evanston Hospital in Evanston, IL. “This

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ome of the case studies presented at SCAI’s Hemodynamics Symposium fool not only the audience but the faculty as well, says Zoltan G. Turi, M.D., FSCAI. “In one case, the patient looks like he has severe stenosis, but he actually has no stenosis at all,” says Dr. Turi, who co-chairs the symposium with Morton J. Kern, M.D., FSCAI. “It’s purely artifact. The scary thing is that in the real world, physicians make decisions— occasionally including replacing heart valves—based largely on artifact.” Teaching participants how to distinguish between true pathology and mere artifact is one of the goals of the full-day symposium, which focuses exclusively on the fundamentals of diagnostic catheterization. This year’s Hemodynamics Symposium will be held Wednesday, May 6, in Las Vegas, NV, as part of the

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Call to Action

SCAI Urges Members: Speak Out on Proposed Publicly Reported Outcome Measures Based on Imperfect Methodology

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ollowing hearings held by the National Quality Forum (NQF) in March, SCAI expects NQF to “call for public comments” this month on 30-day PCI all-cause mortality outcomes. While the Society embraces accurate, easy-to-understand public reporting as a useful tool that will help patients more actively participate in their healthcare, SCAI is urging NQF to

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SCAI 2009 (cont’d from pg 1) is really a chance to synthesize a lot of information into something people can take back home with them.”

Maintenance of Certification For those who took the first Board certification exam in Interventional Cardiology 10 years ago, 2009 is the deadline for recertification, including completing Maintenance of Certification (MOC) requirements. For many, the complexity of the recertification process has come as a surprise. In addition to sitting for a recertification exam, applicants must earn 100 MOC points through a self-evaluation process. Of these, at least 20 points must focus on medical knowledge, while another 20 points must focus on practice improvement. The remaining 60 may come from either category. At SCAI’s Annual Scientific Sessions, several sessions will help attendees to work as a group on one of the 20-point self-study modules in medical knowledge available from the American Board of Internal Medicine (ABIM). A group leader will guide discussion and completion of the self-study workbook. At the end of the session, attendees will have everything they need to simply log on the ABIM website (www.abim.org) and enter the correct answers needed to earn MOC points. Attendees can participate in more than one session, completing a different self-study module at each. The practice improvement modules (PIMs) are more difficult to address. They require a combination of surveys (of patients or referring physicians), practice system inventories, and sometimes chart reviews in areas such as preventive cardiology, hypertension, and communication. Cardiologists may also complete PIMs based on the National Cardiovascular Data Registry™ and the Door-to-Balloon Time initiative. Getting a grasp on how PIMs work just by perusing the ABIM website is challenging. “It’s difficult to figure out, so the Society is going to help,” Dr. Feldman says. “We have invested a great deal of time working with ABIM to make this more workable.” The annual meeting will offer sessions on how PIMs work, how to register with the ABIM, and how to get started on completing a PIM. ABIM representatives will be on hand to provide assistance and support. Additional sessions, or parts of sessions, will focus on helping attendees to learn the recertification lingo. Although it won’t be possible to complete most types of PIMs on site, there will be a half-day simulation program featuring a variety of cases that can be started and finished at the meeting, and will help attendees earn the needed 20 PIM points. (continued on page 4)

SCAI’s annual meeting will feature a half-day simulation program aimed at helping interventionalists earn points toward recertification.

SCAI News & Highlights is published by

The Society for Cardiovascular Angiography and Interventions 2400 N Street, NW, Suite 500, Washington, DC 20037 Phone 800-992-7224; Fax 202-689-7224 www.scai.org; www.Seconds-Count.org; info@scai.org Ziyad M. Hijazi, M.D., MPH, FSCAI, President Steven R. Bailey, M.D., FSCAI, President-Elect Bonnie H. Weiner, M.D., MSEC, MBA, FSCAI Immediate Past President Morton Kern, M.D., FSCAI, Editor-in-Chief Norm Linsky, Executive Director _____________________________________________________ Sandra Baxter Surveys and Needs Assessment Kerry O’Boyle Curtis Education, Meetings, and Communication Kathy Boyd David Managing Editor Ryan Donnells Database, IT, and Accounting Eric Grammer Marketing Kim Greene Meetings Joel Harder Quality Initiatives and Clinical Documents Rick Henegar Meetings Andrea Hickman Meetings Sarah Jones Operations and Administration Terie King Accounting and Finance Kimberly Martin Committee Operations Wayne Powell Advocacy and Guidelines Beatrice Reyes Operations Betty Sanger Sponsorship and Development Rebecca Teichgraeber Education Kim Watkins Accounting MultiWeb Communications Online Services touch three Design and Production Imaging Zone Printing


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SCAI 2009 (cont’d from pg 2) “Whatever the challenges are now, the Society is very involved in shaping and improving the process going forward,” Dr. Feldman says. “The concept is very positive, but we’re making it productive and userfriendly, too.”

Practice-Changing Trials The 2009 Annual Scientific Sessions will also offer new sessions designed to ease the daunting task of keeping up with—and making sense of—an explosion of clinical trial data. “There are so many Late-Breaking Clinical Trials these days,” Dr. Feldman says. “What we see at the typical trials sessions are a lot of slides and an avalanche of data, but it’s difficult to put it all in context.” The problem of data overload is only amplified by the recent upsurge in subspecialty journals, he adds.

The answer is to focus more on the forest and less on the trees, to identify broad clinical themes, synthesize the recent data in that subject area, and put it all together. At the 2009 Annual Scientific Sessions, three news sessions will do just that. Dubbed Practice-Changing Trials and Abstracts, these sessions will explore the latest information on multivessel and left-main PCI, ST-segment elevation myocardial infarction, and stenting—and answer the burning question, “What does it all mean?” “I want people to walk out of those sessions saying, ‘I understand which of these trials should be changing my practice, and how,’” Dr. Feldman stresses. “We’ll see a real synthesis of information, instead of a fragmentation of information.” To register for the annual meeting, log on to www. SCAI.org, or complete and fax back the registration form on page 3. n

SCAI Committee Meetings for 2009 • Saturday, March 28, 2009, during the ACC Annual Scientific Sessions, in the Renaissance Orlando at Seaworld in Orlando, FL— See page 15 for the complete schedule! • Wednesday, May 6, 2009, during SCAI’s 32nd Annual Scientific Sessions, in Caesars Palace, Las Vegas, NV • Monday and Tuesday, September 21–22, 2009, during TCT 2009, in San Francisco, CA Remember — SCAI’s unique open-door policy means that every SCAI member is invited to attend the committee meetings of their choice. No formal appointments, no need to RSVP. Just take a look at the schedule and see what interests you. Then come check it out!

For details on the meetings of individual committees, visit www.SCAI.org or call 800-992-7224.


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Structural Heart Disease Council Launches Ambitious Projects

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CAI’s new Structural Heart Disease Council is off to a productive start, having already launched several initiatives aimed at guiding the future of this growing subspecialty and smoothing the way for new device approval. Since meeting for the first time last fall, the Council has initiated a member survey, begun work on a training and competency document, and met with the Food and Drug Administration (FDA) to discuss alternative pathways for the approval of devices for the treatment of structural heart disease—conditions that often are too rare to satisfy the statistical requirements of a randomized controlled clinical trial. “Structural interventions have been around for a long time. But new technology and new techniques are rapidly expanding the population of patients we’re treating,” says Ted Feldman, M.D., FSCAI, co-chair of the Structural Heart Disease Council and director Ted Feldman, M.D., of the cardiac catheterization FSCAI laboratory at Evanston Hospital in Evanston, IL. “The Council was developed to provide structure and direction to the field as it develops.” Chairing the Structural Heart Disease Council with Dr. Feldman are Ziyad M. Hijazi, M.D., MPH, FSCAI, SCAI President and director of the Rush Center for Congenital & Structural Heart Disease and chief of pediatric cardiology at Rush University Medical Center in Chicago. The Council’s co-chair is Carlos E. Ruiz, M.D., Ph.D., FSCAI, director of the Structural and Congenital Heart Disease Center at Lenox Hill Heart and Vascular Institute of New York in New York City.

Survey and Standards One of the Council’s first steps was to devise a survey to get the lay of the land. Once fielded, the survey will provide insight into such questions as how many interventionalists are performing structural heart disease procedures, which procedures they are performing, and in what volume. In addition, the survey will help determine how many interventional cardiology training programs include a special emphasis on structural heart disease in the curriculum, as well as how many post-fellowship programs focus exclusively on interventional therapy for structural heart disease. At the same time, the Council is developing a training and educational standards white paper. This document is intended to define a core curriculum not only for formal training programs, but also for self-study

by practicing interventional cardiologists and others with a background suitable for training in structural heart disease interventions. “I would like to bring down the barriers we have so solidly built around cardiologists that separate us from surgeons and pediatricians,” Dr. Ruiz says. “There is room for training people into this field who come from different backgrounds, and for pediatric cardiologists to do Carlos E. Ruiz, M.D., more adult structural heart disease Ph.D., FSCAI if they want to.” Today there are no standards that describe the recommended education and training for performing structural heart disease interventions. One of the challenges in drafting recommendations is that familiar standards that work for coronary or peripheral interventions don’t apply to structural heart disease. It would be impossible to define competency on the basis of performing a high volume of procedures, for example. “The procedural volume in structural heart disease is a couple of orders of magnitude lower than in coronary disease, and the procedural complexity is much higher. So how do you define a training standard?” Dr. Feldman asks. “A lot of people are trying to get into the field, and they need some guidance. We want to bring resources together where people can find them.” Creating tiers of training, based on procedural complexity, is one option the Council is weighing, Dr. Ruiz says. Simulation training will also likely play a large role, according to Dr. Feldman.

OPCs Not even a handful of devices have been approved by the FDA specifically for structural heart disease. As a result, many procedures are performed for “offlabel” indications. “We have not one single stent approved for pediatric use for congenital anomalies,” Dr. Ruiz explains. “There are no stents approved for the pulmonary arteries, for the pulmonary veins, for conduits, for coarctation—nothing.” The problem is that the conventional regulatory process is so lengthy and costly that manufacturers generally won’t even attempt to win FDA approval for a device whose market potential is small. The Structural Heart Disease Council is meeting with the FDA to explore alternatives, and is finding the agency receptive. “They are very supportive and willing to work with the Council in exploring these alternative pathways


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“SCAI’s Structural Heart Disease Council welcomes new members. It comprises an executive committee of 15 members with voting privileges and an unrestricted Structural Heart Disease Work Group, which is open to anyone interested in participating. To join, members can simply send an email to Dr. Hijazi at president@scai.org”

and coming up with solutions to get new devices to market,” Dr. Ruiz explained. The path the Council is taking is in developing objective performance criteria, or OPCs. The OPC process involves convening a multidisciplinary panel of experts that includes pediatric cardiologists, interventional cardiologists, noninvasive cardiologists, and surgeons. Each expert panel focuses on a particular device. After examination of the scientific literature and infusion of their own experience and wisdom, the panel determines an acceptable morbidity and mortality for the procedure, as well as the type of complications that might be expected and a reasonable rate of complications. Once these standards have been established, a study is conducted. The FDA can use study data to determine whether the device meets established standards and should be approved. In late-January, several members of the Council met with FDA representatives in the Interventional Cardiology Device Branch to discuss the possibility of developing OPCs. The FDA gave the go-ahead to establish multispecialty writing committees to develop inclusion and exclusion criteria and to develop a balanced review of the literature in three areas: paravalvular leaks, post-infarct ventricular septal defects, and stents for branch pulmonary arteries. The Council will meet again with FDA representatives, this time from the Circulatory Support and Prosthetics Branch, to confirm their support for developing OPCs for percutaneous pulmonary valves. Dr. Ruiz has successfully navigated the OPC process in the past, as part of a group that won approval of a device for occlusion of patent ductus arteriosus. “If we are willing to work together—surgeons, interventionalists, everybody—we can really accomplish this,” Dr. Ruiz says. “The FDA is very interested in facilitating the process, but at the same time they want to be sure they are not bound to what we come up with. They are an independent agency, and that’s how it should be.” SCAI’s Structural Heart Disease Council welcomes new members. It comprises an executive committee of 15 members with voting privileges and an unrestricted Structural Heart Disease Work Group, which is open to anyone interested in participating. To join, members can simply send an email to Dr. Hijazi at president@scai.org n

Mark Your Calendar SCAI-CREST Brings Education Straight to YOU April 2009 • April 8 – San Diego, CA • April 15 – Richmond, VA May 2009 • May 6 – Las Vegas, NV • May 13 – Oklahoma City, OK • May 14 – Nashville, TN • May 20 – New Orleans, LA June 2009 • June 10 – Cincinnati, OH • June 11 – Louisville, KY • June 11 – Boston, MA • June 17 – Charlotte, NC • June 18 – Orlando, FL July 2009 • July 15 – Salt Lake City, UT • July 16 – Denver, CO August 2009 • August 19 – Philadelphia, PA • August 20 – Newark, NJ September 2009 • September 3 – Jacksonville, FL • September 16 – Sacramento, CA • September 17 – Seattle, WA • September 23 – Madison, WI • September 24 – Detroit, MI SCAI has undertaken its regional education program with its own resources as well as support from Daiichi Sankyo, Inc. and Eli Lilly and Company, The Medicines Company, and Cordis Cardiac & Vascular Institute. The Society gratefully acknowledges this support, while taking sole responsibility for all content developed and disseminated through this effort. Note: The SCAI-CREST schedule is subject to change. Please visit www.scai.org for up-todate information on SCAI-CREST programs.


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SCAI Announces 2009 Interventional Cardiology Fellows-in-Training Grant Winners For the second consecutive year, SCAI has administered a program that awards millions of dollars to medical centers to train interventional cardiologists. Joseph D. Babb, M.D., FSCAI, chair of the Fellow-in-Training Grant Committee, calls this program “a huge step forward in fulfilling SCAI’s role of leadership in interventional cardiovascular training and education.” It all started, explains Dr. Babb, with SCAI leadership having in-depth discussions with large U.S. companies that make interventional devices. These companies were interested in addressing concerns about customer bias in the educational granting Joseph D. Babb, M.D., process. “They saw the wisdom FSCAI of supporting graduate medical education,” says Dr. Babb, “and they had the courage to give the funds to SCAI to administer it fairly and equitably to training programs. “It is the right thing, for the right reasons, at the right time,” continues Dr. Babb. “By all predictions, there will soon be an overall decrease in interventional cardiologists.” SCAI is dedicated to offsetting that trend by doing everything it can to maintain fellowship programs at full capacity.

Selection Process The SCAI Fellows-in-Training Grant Committee is responsible for reviewing the applications and determining which institutions will receive awards to help cover the education, salary, and benefits of physicians training in Interventional Cardiology. Only medical centers with proven track records and openings approved by the Accreditation Council for Graduate Medical Education (ACGME) are considered for the grants. Dr. Babb and the other members of the committee, Morton J. Kern, M.D., FSCAI, Michael J. Lim, M.D., FSCAI, Karen M. Smith, M.D., FSCAI, and Barry F. Uretsky, M.D., FSCAI, met throughout the year to administer the program. Applications were submitted online and then graded by at least three independent evaluators. Dr. Babb called and offered feedback to each applicant not chosen, thus improving their chances for next year. This year, three of the awards went to peripheral vascular and structural heart disease programs. “Non-coronary vascular intervention and structural heart disease interventions are a fertile and growing area,” says Dr. Babb, “so part of our aim was to begin

the process of supporting programs with exemplary non-coronary vascular training and structural heart disease training.”

Award Sponsors and Recipients SCAI thanks the Boston Scientific Foundation, Cordis Cardiac & Vascular Institute, and Medtronic for their generous and unrestricted grants and congratulates the following institutions selected to receive funding in 2009: • • • • • • • • • • • • • • • • • • • • • • • • • • •

Aurora Health Care Baylor University Baystate Medical Center Beaumont Medical Center Bridgeport Hospital Case Western Reserve Cleveland Clinic Columbia University Cornell University Creighton University Duke University Eastern Carolina University Evanston Hospital George Washington University Indiana University Johns Hopkins University Loyola University Massachusetts General Hospital Northwestern University Ochsner Medical Foundation Ohio State University Rush University Medical Center St. Louis University Stanford University Tufts University University of Alabama University of Arkansas

• University of California at

Davis • University of California at

Irvine • University of California at

San Diego • University of California at • • • • • • • • • • •

• • • • • •

San Francisco University of Cincinnati University of Florida University of Iowa University of Louisville University of Mississippi University of Missouri — Kansas City University of Nebraska University of Pittsburgh University of Rochester University of Texas Health Sciences Center at Houston University of Texas Health Sciences Center at San Antonio University of Utah Vanderbilt University Virginia Commonwealth University Washington Hospital Center Washington University Yale University

“Our industry partners are to be applauded for their vision to underwrite and fund this process,” says Dr. Babb. “We’re honored that they had the trust and faith in SCAI to represent the highest standards of interventional cardiology education and fairly administer these funds.” For more information about the interventional cardiology training grants, visit www.SCAI.org n


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Advocacy & Guidelines Call to Action (cont’d from pg 1) phase-in the proposed measurement model and actively monitor for unintended consequences through a rigorous validation process. “Timelimited endorsement” is the right message that the Interventional Community needs to send to NQF, say SCAI leaders. “‘Full endorsement by NQF’ is a powerful phrase, meaning that Medicare patients can trust that these measures do what they are supposed to do, and use the results without question in their healthcare decisions,” explains SCAI President Ziyad M. Hijazi, M.D., MPH, FSCAI. “‘Time-limited endorsement’ sends out the right message to patients that physicians want to deliver on our promise for public reporting on meaningful outcome measures, but also recognizes that statutory limitations make it difficult to fully advance on that promise.” As one example of a statutory barrier, Dr. Hijazi cites the need for reform of privacy regulations for quality improvement. SCAI is poised to respond to NQF during the comment period and is strongly encouraging members to make their voices heard.

Path to Public Reporting As physicians in New York and Massachusetts know, public reporting of outcomes is not a new concept and has its challenges. New York has made CABG and PCI data available since 1989 and 1994, respectively. In 2003, Massachusetts followed with public reporting of outcomes from all coronary interventional procedures. Based in part on the experiences of these states, the Centers for Medicare and Medicaid Services (CMS) sought the input of experts-at-large to develop quality measures for full endorsement by NQF. A member of NQF, SCAI has participated in the Forum’s deliberations on how best to launch public reporting of quality measures for PCI. Most recently, SCAI’s representative to NQF, Charles Chambers, M.D., FSCAI, testified during the Forum’s hearings on the measurement model under consideration. SCAI testimony aimed to address its limitations and provided recommendations on how to improve the measure methodology. If implemented as proposed, the model would combine the 30-day PCI all-cause mortality data from two sources, the ACC-NCDR™ CathPCI

Registry and CMS claims data, to arrive at a “grade” for each hospital that performs PCI and participates in the NCDR and Medicare. These “grades” would be available online to the public, who may have little interest in how they were formulated, Charles Chambers, or how they are impacted by M.D., FSCAI physician subjectivity, such as cardiogenic shock or the reality that some physicians are equipped to treat sicker patients and may, therefore, have higher death rates. Most worrisome to SCAI is that the proposed model for public reporting of PCI outcomes would be implemented with full endorsement. Combining Medicare claims data with other databases without direct matching of patients and publicly reporting those findings before there is an absolute assurance that this is a sound methodology is premature and troubling. “The message SCAI has been sending, and the one I hope members will reinforce to NQF, is that we need to put checks and balances into the system before launching full-scale public reporting. Right now, NQF is moving toward unchecked support of a system based on potentially inaccurate data,” says Dr. Chambers. “Once implemented, it’s very difficult to correct. Therefore, it must be validated up front.”

Do the Data Make the Grade? To arrive at a public reporting model that will achieve its stated aim — namely, to improve quality — the first priority is getting the right data, and enough of it, stresses Dr. Chambers. “There are a number of potential problems with the data, but the most concerning is that the proposed model won’t grade all physicians according to the same score-card,” he explains. When the Yale New-Haven Hospital Center for Outcomes Research and Evaluation (YNHH CORE) retrospectively tested its proposed model for data collection, it linked data from the CathPCI Registry, on which SCAI is a partner, and historical Medicare claims data. The result of the retrospective analysis: only 65 percent of the data were successfully matched. The other 35 percent


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of relevant claims data on Medicare beneficiaries essentially disappeared. Why? One reason is privacy regulations prevent the measure developer from using patient name, Social Security number, or other direct identifier for quality improvement. Another possible explanation relates to hospital protocols on admission of PCI patients. Patients treated on an outpatient basis, a practice becoming increasingly common for non-STEMI patients, aren’t included in the analysis that produces the hospital grades. But some hospitals have stricter interpretations of when patients can undergo PCI as outpatients, a fact that potentially helps them achieve better grades because they’re admitting more — and arguably healthier — patients whose outcomes inform their hospital-level publicly reported grades. Similarly, there is concern that the grading system won’t adequately adjust for the especially complex (referred to as “salvage” or “compassionate use” cases), where the likelihood of mortality is high with or without PCI. “Some physicians are able and willing to take on the cases that no one else will because the patient has no other options, but regardless of risk-adjustment, a death is a death when you boil it down to score-cards,” says Dr. Chambers. From the measure specifications, the death will count against the physician even if it was not cardiovascular-related or directly linked to the procedure. The other variables SCAI worries will be overlooked are the subjective ones, such as cardiogenic shock. “Here it comes down to nuances,” explains Dr. Chambers. “What one doctor submits to CathPCI Registry as shock may be coded as STEMI by another.”

Call to Action When SCAI testified to NQF’s Technical Advisory Panel, they voted as SCAI had hoped, unanimously in favor of “time-limited endorsement” of the proposed approach to public reporting. This would allow the system to be phased in, with datavalidation required to be reviewed within 12 to 24 months into the program. “SCAI believes a phased-in approach protects the safety of patients. We believe patients deserve to know how hospitals perform, which is why

we support public reporting; however, we favor incremental, data-driven approaches that will yield high-quality measures that will give patients a full and accurate picture of the care doctors provide,” he explains. “Let’s get it right from the start, because once you give someone a bad grade, it’s very hard to correct it.” Unfortunately NQF’s Steering Committee chose to disregard the unanimous vote of its Technical Advisory Panel, instead voting in favor of implementing the system without SCAI’s recommended checks and balances. ‘Full endorsement’ means that the measure will enter public reporting programs and may not be checked for 36 months (much longer than ‘timelimited endorsement’). “I was disappointed in the Steering Committee’s vote and gravely concerned about the potential impact of this decision,” says Dr. Chambers. “A worst-case scenario is that physicians will be afraid to take on the toughest cases, those with the least chance of positive outcomes, because those outcomes, no matter how unavoidable, will impact their grades and their patients’ trust in them.” What happens now? SCAI expects that NQF will call for public comments in April. The following 30 days will be an open comment period, during which SCAI will submit feedback and urge NQF to revise the measure specification for “time-limited endorsement” and address all of the concerns of the Interventional Cardiology community. The voices of interventional cardiologists will be invaluable in reinforcing SCAI’s message and persuading NQF to reconsider their decision. “Time-limited endorsement sends the right message that further testing of publicly reported measures is warranted and that physicians want measures to be done right, the first time,” stresses Dr. Chambers. Here’s how you can help: SCAI urges interested physicians to evaluate the measures, the measure methodology, and comment at: http:// www.qualityforum.org/projects/ . For more information or guidance on how you can express your views to NQF, contact Joel Harder, SCAI’s Director for Quality Initiatives and Clinical Documents, at jharder@scai.org or 202-552-0910. n


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Hemodynamics Symposium (cont’d from pg 1) Society’s Annual Scientific Sessions. Launched in 2006, the symposium has been a standing-room-only event ever since. What’s behind that success? According to Dr. Turi, interventional cardiologists are hungry for education on the basics of their craft. “For the last 20 years, we’ve had the evolution of a lot of exciting new technologies,” he explained. “Somewhere along the way, we stopped focusing as much on Zoltan G. Turi, M.D., teaching the basics.” This program FSCAI fills the void for physicians who want to learn—or re-learn—those fundamentals. Combining short talks, case studies, and an audienceresponse system that lets participants assess their knowledge, the symposium offers a complete overview of hemodynamics, coronary and peripheral angiography, and structural heart disease. By the time the nine-hour program is over, participants have the knowledge they need to stop over-relying on their computers. “As one of our speakers says, the cardiac cath lab has become a picture-taking studio,” says Dr. Turi. “You generate a lot of data, much of which is just noise.

“Somewhere along the line, we stopped focusing as much on teaching the basics. This program fills the void ...” ~ Zoltan G. Turi, M.D., FSCAI We try to provide the insights to help you differentiate between noise and physiology.” To keep things fresh for the many attendees who come back year after year, roughly half of the faculty at the 2009 event will be first-timers. Also new is an emphasis on connecting the material covered in the course to the new technologies, such as percutaneous heart valves, featured during the overall SCAI meeting program. “What we’re doing is teaching diagnostics and making it relevant for people really excited by the new technology coming out,” says Dr. Turi. n

Founders’ Lecture

Dr. Teirstein Will Explore Opposing Viewpoints on PCI Volume In his Founders’ Lecture at SCAI’s 32nd Annual Scientific Sessions in Orlando, Paul Teirstein, M.D., FSCAI, will argue that percutaneous coronary intervention (PCI) is underutilized. Dr. Teirstein is Chief of Cardiology and Director of Interventional Cardiology at Scripps Clinic in La Jolla, CA. He also founded and directs the Interventional Cardiology Fellowship Program at Scripps. “PCI has conveyed enormous benefits to patients with a wide spectrum of coronary artery disease,” says Dr. Teirstein, a respected researcher and clinician who has been at the cutting edge of Interventional Cardiology for many years, “A lot of the discussion about the overuse of Paul Teirstein, M.D., interventional cardiology procedures FSCAI is misguided.” Clinical trials like COURAGE and SYNTAX have been misinterpreted and then embraced by those who favor a reduction in PCI volume, while in reality these trials have a different message to deliver, explains Dr. Teirstein.

The COURAGE trial, for example, is often cited as showing no benefit from PCI when used in addition to the best available medical therapy. Dr. Teirstein disagrees and plans to explain during his lecture why “the COURAGE trial does not apply to most of our patients,” he says. Similarly, the SYNTAX trial pointed to bypass surgery as the standard of care for patients with three-vessel or left main coronary artery disease. Dr. Teirstein sees things differently and will encourage attendees to interpret the data from the patient’s perspective. “I think the SYNTAX trial supports increased use of coronary stenting in patients with extensive coronary disease,” he says. Unless clinical trial data are examined fully and interpreted correctly, patients may be inappropriately denied procedures they need, Dr. Teirstein says. “In reality, more patients should be given the opportunity to have the benefit of percutaneous revascularization.” Dr. Teirstein will deliver the Founders’ Lecture on Thursday, May 7. To register for SCAI’s annual meeting, where you can attend Dr. Teirstein’s Founders’ Lecture, complete the registration form in this newsletter, call 800-992-7224, or visit www.SCAI.org n


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In the Trenches Busy Interventionalist Strikes a Balance

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hen Roxana Mehran, M.D., FSCAI, was a medical resident and then a cardiology fellow, her hobby was running marathons. She gave up the avocation when interventional cardiology captured her attention. It was then that the everyday demands of her career, Dr. Mehran was a cardiology fellow when she found herself and, later, her family, hooked on the potential of began requiring the Interventional Cardiology. “I had to go for it!” she says. strength and stamina of a runner as well as meticulous organization, focus, hard work, and the generous support of her colleagues at Columbia University Medical Center and the Cardiovascular Research Foundation (CRF) in New York City. Dr. Mehran wears many hats. She is a fulltime interventional cardiologist and Director of Outcomes Research at the Center of Interventional Vascular Therapies at Columbia University, where she is also Associate Professor of Medicine. She is the Medical Director of the Data Coordinating and Analysis Center at CRF, a wife (her husband, George Dangas, M.D., Ph.D., FSCAI, is also an Interventional Cardiologist at Columbia University), and the mother of three young children (the oldest is 9). She is also a highly sought speaker who travels throughout the world delivering lectures on the latest advances in interventional cardiology. She says that hard work and a bit of luck have helped her achieve her accomplishments, but she is also quick to point out the help she has received through the years from many of interventional cardiology’s “wonderful, brilliant, and nurturing thought-leaders.”

Going for It It wasn’t long after Dr. Mehran, then a cardiology fellow, found herself gravitating toward Mount Sinai Medical Center’s Cardiac Catheterization Laboratories that she realized she was hooked, her calling clear. “I just had to go for it,” she says.

Her fascination with the field of interventional cardiology had begun when she was a medical student. “It was the only field in cardiology where I felt that there was a real translation of bench to bedside,” she explains. “Experiments could be done in a laboratory, mechanisms understood, and then applied in patients, and the results would be seen very soon thereafter. This is a unique aspect of interventional cardiology that I think most fields do not have.” The timing was right, too. She completed her interventional cardiology training in 1995, at a time of tremendous innovation in the field. “There was an incredible surge of energy, with new devices, angioplasty, and stents. I discovered that intravascular ultrasound was a very valuable tool to allow us to better understand the in vivo mechanisms of new devices and follow outcomes in our patients. I was very passionate about interventional cardiology.” That passion was also sparked by the opportunities she had to work with some of the giants in cardiology. “I was very lucky,” she says. “I had Dr. John Ambrose as one of my mentors, also Richard Gorlin, Valentin Fuster, and Samin Sharma … such incredible people. I also had the opportunity to work with Andy Marks, who was exploring the mechanisms of rapamycin, which became the sirolimus-eluting stent. It was a fortuitous set of circumstances that allowed me to be exposed to such amazing people during my fellowship. Mount Sinai was a very exciting place to be at that time.”

Mentored by a Visionary Next, says Dr. Mehran, came a mentor who let her “flourish.” In 1995, Martin Leon, M.D., FSCAI, invited her to join Washington Hospital Center in Washington, DC. There she became involved in overseeing the Center’s Clinical Research Outcomes Database. “I was working under Marty’s supervision. He’s the perfect example of a person who is there when you need his shadow but then steps away to make sure you see the sun and the sun sees you. In our field, it is rare to find people like that, who are so secure in their own place that they allow and encourage young researchers to develop their potential. He should be given an award as the model mentor in interventional cardiology.”


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When the Center moved to New York City in late 1999, Dr. Mehran, who was born in Iran but who came to New York with her parents when she was a little girl, found herself back in her hometown. There, with support of mentors such as Dr. Gregg Stone, she continued her work in developing the Data Coordinating and Analysis Center at CRF, which is now one of the largest centers for organizing and oversight of pivotal clinical trials in interventional cardiology. She was also able to build her clinical practice in interventional cardiology with the help of Dr. Jeffrey Moses, Director of the Center of Interventional Vascular Therapies at Columbia University.

A Challenge Every Minute Today, her biggest challenge is balancing home and work, making sure that she fulfills her commitments to both family and career. She says that she must make compromises on both sides of her balancing act, and sometimes it hurts to do so. “I’m not able to be at every single drop-off and pickup for my children, but I try very hard to balance that with quality time with them,” she notes. Such are the huge challenges faced by women with both careers and families, she adds. “The challenges are every day, … they’re every minute, actually. Every time I plan something, I must take into account what consequences it will have on my time with my family.” Her saving grace is her husband, she says. “I’m very lucky in that my partner in life, George, is extremely supportive and is always there to be sure that we both feel fulfilled, as much as we can, on the family front as well as on the work front. And so I’ve learned to accept to take smaller steps when needed on the work front, so that I can be there for my family.” Achieving balance may be a challenge of marathon proportion, but it is one Dr. Mehran fully embraces. “Many times, the measures of success in our field are very much driven by what you know, who you are, what you do, how many papers you publish,” she says, “But I think the measure of success should be in the balance of being able to be a good person as a whole, and to have a balanced family life as well as a fulfilling and successful career. And that’s a challenge. Every day.” n

An Opportunity to WIN: New SCAI Committee Tackles Gender Disparities in Cardiovascular Health

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eart disease is widely known to be the number-one killer of women, but why this is remains unclear, evidencing a need for clinical research and innovations. To address the need, SCAI recently launched the Women in Innovations, or WIN, Committee. Chaired by Roxana Mehran, M.D., FSCAI, Bonnie Weiner, M.D., MBA, MSEC, FSCAI, and Alaide Chieffo, M.D., the committee will tackle issues facing women’s cardiovascular health on three fronts: • research, • education, and • professional development. Check out the next issue of SCAI News & Highlights for details on the committee’s goals, its plan for achieving them, and how you can participate.


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