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September/October 2009

The Society for Cardiovascular Angiography and Interventions

SCAI Position Paper Clarifies Selection of Contrast Media: Expert Panel Cuts Through Conflicting Scientific Literature

Y SCAI Delivers Specialty Care Concerns to the Hill

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everal SCAI leaders recently joined representatives from nine other specialty groups in the Alliance of Specialty Medicine to meet face to face with key legislators in the halls of Congress to ensure that the best interests of interventional cardiology professionals and their patients are represented and heard. The three-day Alliance of Specialty Medicine Legislative Conference held July 13–15 was attended by both chairs of SCAI’s Advocacy Committee, Joseph D. Babb, M.D., FSCAI, and Mark Turco, M.D., FSCAI, as well as Christopher U. Cates, M.D., FSCAI, Robert Vincent, M.D., FSCAI, and Bonnie Weiner, M.D., MSEC, MBA, FSCAI. Seventy specialist physicians from the Alliance joined forces to protect their patients’ access to high-quality specialty care by participating in the debate on Medicare and healthcare reform. “This was our first opportunity to work with the Alliance and its members from multiple specialty areas throughout medicine,” says Dr. Babb. “The commonality of concerns was impressive.” “It was prudent from an advocacy standpoint to join with the Alliance because its mission is to promote education on

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ou would think that the selection of contrast media for PCI would be simple after all these years, but it’s not. Take variations in chemical composition, ionicity, osmolarity, and viscosity—and blend in conflicting clinical study data and vendor financial incentives—and you have fertile ground for uncertainty and confusion. “Every company wants to suggest that their product is better than another,” said Lloyd W. Klein, M.D., FSCAI, a professor of medicine at Rush Medical College, and Lloyd W. Klein, M.D., director of research in the Department of FSCAI

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Washington State HTA Committee Votes Against Restricting Patient Access to DES In a surprising reversal of course, the Washington State Health Technology Assessment (HTA) Committee voted against its proposal to restrict coverage of drug-eluting stents (DES) for stateinsured employees and Medicaid beneficiaries. The decision came following strong feedback from SCAI, the Washington State Chapter of the ACC, and many interventionalists who practice in the state, including SCAI President-Elect Larry Dean, M.D., FSCAI. In a letter submitted to the HTA committee earlier this month, SCAI and Washington’s ACC chapter urged the HTA to reconsider its recommendations to restrict coverage of DES to all but patients considered to be at the highest risk. SCAI pointed out that limiting DES coverage to patients based on lesion length, lumen diameter, and diabetic status, as the HTA was Larry Dean, M.D., recommending, would deprive many of the state’s FSCAI

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Advocacy To the Hill (cont’d from pg 1) the importance of specialty medicine as it relates to healthcare and patients,” adds Dr. Turco. “The issues we raised will allow for a more intensive discussion as the healthcare bill continues to take form.”

Three Days of Access During the first two days of the conference, Alliance members met with and heard from Senate and House leaders integrally involved in the healthcare debate, including House Majority Leader Steny Hoyer (D-MD). “There was some very interesting and frank discussion during those sessions such as limiting access to specialty providers and cuts in reimbursement to specialists through the use of the SGR (sustainable growth rate),” says Dr. Turco. Alliance members spent the third day of the meeting with congressional representatives and senior healthcare staff advisors, or health legislative aides (HLAs), from their respective home states. “We had great access,” says Dr. Turco. “We could gauge their reaction to our message and answered their questions directly.” Making Progress In addition to protecting patients’ access to specialty services, broad areas of discussion included the need to reform current formulas for Medicare physician payment and to amend the incentive timelines for implementation of health information technology. “The questions we asked and the information we provided was eye-opening to some extent to the legislators,” says Dr. Turco, who was pleased to find support for many of SCAI’s concerns, particularly around efforts to correct the SGR formula currently used by the Centers for Medicare and Medicaid Services to calculate physicians’ fees. “Everyone agreed that the system needs to be changed and improved,” says Dr. Babb, who found the in-person visits helpful in relaying a deeper understanding of complex issues. “But we want to be careful and thoughtful about the process of change.” In his meetings, Dr. Babb stressed the importance of defining and interpreting key terms. He explained to HLAs that primary care isn’t a “sign on the door.” “The reality is that many sub-subspecialists deliver a significant amount of primary care on an ongoing basis to their patients,” explains Dr. Babb. “You could see from their reactions that we had helped them reframe what primary care really is.” The physicians also spoke at length about the national workforce strategy to help legislators understand that physician shortages are a problem

for the specialties as well as primary care. Other hot topics included comparative effectiveness research and the authority of the Medicare Payment Advisory Commission (MedPAC). “This opportunity to speak with the lead healthcare staff or directly with the senators and representatives,” says Dr. Turco, “was very important because the more they hear our message, the better chance we have to help them with healthcare reform.”

Can You Help? “We want to make it easy for our members to hear what’s going on and respond directly to their elected officials,” says Dr. Babb. Not everyone can make it to the Hill in person, but the Society will help members participate in any way they can. Members should consider joining the Advocacy Committee, calling legislators, or drafting letters and emails. For more information on how you can participate, visit the SCAI Advocacy Action Center at http://capwiz.com/scai

Key Points While on Capitol Hill and in the weeks since, SCAI’s leaders and staff have stressed key points such as these: On Healthcare Reform, SCAI Supports: • Protecting our patients’ access to high-quality specialty services • Comparative effectiveness research (CER) designed to improve the quality and value of healthcare • Medical liability protections for healthcare providers who follow practice guidelines recommended by the CER entity • A public health insurance plan that maintains critical access to specialists but that does not require mandatory participation by Medicare providers • A national workforce strategy that provides adequate funding for both primary and specialty care training • Continued oversight by Congress of MedPAC’s reimbursement and cost reduction recommendations On Medicare Physician Payment Reform, SCAI Supports: The repeal of the inherently flawed SGR formula A long-term and stable mechanism for updating Medicare fees based on a fair model for reimbursement that recognizes the importance of both primary and specialty care

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On Health Information Technology, SCAI Supports: Adjusted timelines for incentive payments given the need for specialty-specific, certified health information technology systems


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“The Society cares about members’ concerns and wants to be the responsible voice for interventional cardiology,” says Dr. Babb. “We’re a member organization. Our job is to advocate for and represent the concerns of our members and the patients we serve.” “There’s no doubt that reform is on its way,” says Dr. Turco. “Our days spent on Capitol Hill this past July will go a long way toward promoting the excellent individualized, highly specialized cardiovascular care that our members provide to a large patient population, but there’s more to be done. The Advocacy Committee remains fully engaged, working hard to ensure our patients’ access to quality care and the resources we need to provide it.” n

SCAI Advocacy Action Center SCAI’s new advocacy tools at http://capwiz.com/scai will help you respond quickly and easily to the most important and time-sensitive advocacy issues of the day by providing – • direct links to issue-specific emails and letters that you can edit and personalize • correct contact information for the agency involved or your representatives based on zip code • legislative alerts and updates • tips on calling representatives • election and key vote result • Senate and House hearing schedules

Contrast Media (cont’d from pg 1) Medicine at Illinois Masonic Medical Center, both in Chicago. “These agents are very expensive and we use so much of them. Cath lab directors have to think carefully about which ones to select. It’s a big call.” A new SCAI position statement brings clarity to a challenging subject. Drafted by a broad-based panel and published online in Catheterization and Cardiovascular Interventions: Journal of the Society for Cardiovascular Angiography and Interventions, the paper not only offers a focused review of the scientific literature; it features a new summary analysis of the 12 best randomized trials published to date on the use of contrast media in PCI. “A lot of information has been published in the medical literature and not all of it is easy to interpret,” said Barry Uretsky, M.D., FSCAI, SCAI past president as well as director of interventional cardiology at the Central Arkansas Veterans Administration Hospital and a Barry Uretsky, M.D., professor of medicine at the University FSCAI of Arkansas for Medical Sciences in Little Rock. “SCAI felt that an authoritative document approved by the Society would give interventional cardiologists an up-to-date, evidence-based education on the relative merits and disadvantages of different classes of contrast agents.” After review and extensive discussion, the authors reached the following conclusions: • Low-osmolar contrast media are preferred over high-osmolar agents for PCI.

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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

Steven R. Bailey, M.D., FSCAI, President Larry S. Dean, M.D., FSCAI, President-Elect Ziyad M. Hijazi, M.D., MPH, FSCAI, Immediate Past President Christopher U. Cates, M.D., FSCAI, Vice President Carl L. Tommaso, M.D., FSCAI, Treasurer Christopher J. White, M.D., FSCAI, Secretary Morton Kern, M.D., FSCAI, Editor-in-Chief _______________________________________________________________ Trustees Alexander Abizaid, M.D., FSCAI Lee N. Benson, M.D., FSCAI Robert M. Bersin, M.D., FSCAI Tyrone J. Collins, M.D., FSCAI David A. Cox, M.D., FSCAI Runlin Gao, M.D., FSCAI James A. Goldstein, M.D., FSCAI Roxana Mehran, M.D., FSCAI Ian T. Meredith, M.D., FSCAI Issam D. Moussa, M.D., FSCAI Timothy A. Sanborn, M.D., FSCAI Ashok Seth, M.D., FSCAI Kimberly A. Skelding, M.D., FSCAI Corrado Tamburino, M.D., FSCAI Jonathan M. Tobis, M.D., FSCAI Mark A. Turco, M.D., FSCAI Zoltan G. Turi, M.D., FSCAI Trustees for Life Frank J. Hildner, M.D., FSCAI William C. Sheldon, M.D., FSCAI

Staff Norm Linsky, Executive Director Kerry O’Boyle Curtis, Senior Director for Education, Meetings, and Communications Wayne Powell, Senior Director for Advocacy and Guidelines Kathy Boyd David, Communications Director Mary Hogan, Membership Manager MultiWeb Communications, Online Services touch three, Design and Production Imaging Zone, Printing


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Contrast Media (cont’d from pg 3) • Low-osmolar (inclusive of iso-osmolar) contrast media are preferred for patients at risk for contrastinduced nephropathy. • There is insufficient evidence to support the superiority of iso-osmolar contrast media over low-osmolar contrast media for PCI with respect to major adverse cardiac events, and inconsistent evidence to support the superiority of iso-osmolar contrast media over low-osmolar contrast media with respect to contrast-induced nephropathy. • When the totality of evidence from randomized clinical trials is weighed, there is no convincing evidence to suggest that either low- or iso-osmolar non-ionic or ionic contrast media are clearly favored in the setting of PCI. • The thrombotic complications potentially related to contrast media are likely negated by the intense anticoagulation and antiplatelet agents used during modern PCI. “The bottom line is that there is very little difference in agents in terms of contrast-induced nephropathy and ischemic complications,” Dr. Uretsky said. “Claims that there truly are differences are not supported by the scientific data.” Some may find it surprising that the panel did not identify a preference for iso-osmolar contrast media over low-osmolar agents. However, in an in-depth discussion on contrast-induced nephropathy, the authors point

out that preventing this high-risk complication may be more a matter of adequate patient prehydration, careful limitation of contrast volume, withholding of medications that adversely affect renal function, and, perhaps, prophylactic administration of N-acetylcysteine. As for the possible benefits of iso-osmolar contrast media for the reduction of ischemic complications during and after PCI, the data are conflicting. Some evidence supports the superiority of iso-osmolar over low-osmolar contrast media—primarily the COURT and VICC trials—but overall the data suggest that PCI outcomes are slightly better with the ionic contrast agent ioxaglate. “The main point is that all of the agents we reviewed are excellent,” Dr. Klein said. “They each have advantages and disadvantages, but there is no clear winner.” Cath lab directors who have selected a particular contrast agent based on claims of clinical superiority should reconsider, he said. “One of the best ways to use this position paper is in re-evaluating your current contrast choice, looking at all relevant factors including cost, patient population, and individual preference.” The position paper also includes an extensive discussion on the prevention and treatment of anaphylactic reactions to contrast media, including graphical treatment algorithms for mild and severe anaphylactoid reactions and prophylaxis for recurrent contrast reaction. To access the paper, log on to www.SCAI.org. n

Patient Access to DES (cont’d from pg 1) citizens of optimal care, as supported by abundant clinical evidence. SCAI and the ACC chapter cited numerous clinical and observational studies, including SCAAR, HORIZONS-AMI, and the very large Duke Universitybased study comparing DES to bare metal stents (BMS) in more than a quarter-million “real-world” patients. When the HTA convened on Friday, Aug. 28, the group voted 6 to 3 against affirming its earlier recommendations. HTA panelists cited concerns with the recommendations, including issues raised by the interventional cardiology community about how high-risk patients should be defined and the difficulties interventionalists would face in implementing such recommendations. SCAI had voiced strong concerns that the restrictions, if affirmed, would essentially create a two-tiered system of care, where those covered by the state would not have access to technology that privately insured residents would. SCAI also emphasized that such restrictions would compromise physicians’ ability to use their best medical judgment for each patient. SCAI Trustee Robert Bersin M.D., FSCAI, and other cardiologists had previously testified before the HTA

on the issue. In the days leading up to the vote, SCAI arranged for Dr. Dean to be interviewed by national news outlets interested in the story.

What Happens Now? The HTA has indicated that it will assemble an ad hoc committee to re-evaluate how the state covers drug-eluting stents. The HTA continues to express concerns about the cost difference between DES and BMS and will continue to seek ways to limit costs. SCAI is petitioning the HTA for representation on the ad hoc committee. “While we are pleased that the HTA heard our concerns and is taking the time to get their decision right, we also recognize we need to continue to work with the panel to ensure the final recommendation is in the best interest of our patients,” said Dr. Dean. SCAI and the ACC have released a statement, available online at www.SCAI.org, applauding the HTA’s decision and stressing a willingness to participate as the committee continues its deliberations. n


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SCAI to Sponsor First Global Interventional Summit, in Collaboration with Turkish Society of Cardiology

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CAI is underscoring its international commitment by sponsoring the first SCAI Global Interventional Summit in collaboration with the Turkish Society of Cardiology. The event will be held October 21–24, 2010, in Istanbul, Turkey. SCAI Im-

ration, we can all work together to enhance our field and achieve our mission of providing our patients with the best possible care. “What an opportunity—to share the knowledge of specialists worldwide in one educational program,” he adds. The program will have two tracks. Dr. Feldman will direct a track focused on adult coronary, carotid, and peripheral interventions. This track will offer case-based scenarios, with representatives from each country tackling a different topic, presenting a case, and leading the discussion. Dr. Hijazi will direct the second track, on interventions for children and adults with congenital and structural heart disease. This track will be mostly didactic, with lectures on such topics as aortic valve disease, mitral valve Leaders of the Turkish Society of Cardiology met with SCAI during the disease, and hypoplastic left heart syndrome. European Society of Cardiology Congress in late August. Both tracks will feature live cases, performed mediate Past President Ziyad M. Hijazi M.D., MPH, by Turkish and other interventionalists and transmitted FSCAI, and Past President Ted Feldman, M.D., via satellite to attendees at the summit. FSCAI, will direct the program with participation of the President-Elect of the Turkish Society of Cardiol- Bridging East and West The Turkish Society of Cardiology will do much ogy, Professor Oktay Ergene, M.D., FSCAI, FESC. Dr. Hijazi is especially pleased about the collaboration more than help with the event’s logistics, says Dr. Hijazi. with the Turkish Society of Cardiology, which will share Drawing from its 1,500-plus membership of academiits expertise as well as host the meeting. The summit is cians and practitioners, they’ll also share their extensive open to all interventional societies and working groups scientific and medical expertise. Representatives from of cardiology and pediatric cardiology societies around the Turkish Society of Cardiology will serve as members the world, which are being invited to participate on the of the event planning committee and as speakers. The live cases will be performed together with leading interprogram committee and in other capacities. Noting that a growing number of SCAI’s members ventionalists from 12 countries and Turkish intervenare based outside of the United States, Dr. Hijazi tionalists at the major Turkish interventional centers. Turkey is also a great location for a meeting like this, explains why the Society has embraced the idea of a new educational event with an international focus: “SCAI Dr. Hijazi adds. “We were looking for a country strategirepresents all interventional cardiologists around the cally located in the middle of the world,” he explains. globe, so we thought, ‘Why don’t we take what we know “Turkey is ideal, because it bridges Europe and Asia, East and share it with others while at the same time providing and West.” The country’s visa regulations won’t pose a a forum for our overseas members and colleagues to teach problem for potential attendees, he says, and costs are us, too?’ It’s a great opportunity for all of us to learn and lower than in some other potential sites. And the historic city of Istanbul has much to offer sightseers, he adds. improve how we practice our specialty.” Dr. Hijazi hopes the Global Interventional Summit Enhancing Collaboration, Sharing Knowledge will become an annual event, attracting 1000-1200 interMany medical societies are expected to participate in ventional cardiologists from around the world each year. the first Global Interventional Summit. Their assembly “Our current focus is to make sure the 2010 Summit is a will help to achieve one of the event’s goals, namely to success—that everyone who attends the meeting learns promote equal partnership and collaboration among something new that will benefit their patients when they interventional cardiology societies worldwide. go back to their home country,” he concludes. “But the ultimate goal is to improve diagnosis and For more information about the Global Interventional treatment,” emphasizes Dr. Hijazi. “With this collabo- Summit and how you can register, visit www.SCAI.org. n


Scientific Sessions SCAI’s Annual Pediatric/Congenital Heart Disease Lecture Named in Honor of Dr. Charles E. Mullins

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ediatric/Congenital Interventional Cardiology Future Potential for Congenital Heart Disease.” Drawing received special recognition at this year’s on his early career experiences of having to make do Scientific Sessions, held May 6–9 in Las with inflexible, undersized, fixed-cell stents designed for Vegas, with a new keynote lecture. The inaugural speech dedicated to advances in this discipline was given by Charles E. Mullins, M.D., FSCAI, considered to be one of the founders of Pediatric / Congenital Interventional C a r d i o l o g y. D r. M u l l i n s w a s introduced by then–SCAI President Ziyad M. Hijazi, M.D., MPH, FSCAI, who made the surprise announcement that Dr. Mullins’s speech would be the first of an “annual tradition of speeches named in his honor.” Dr. Mullins is “the undisputed father of interventional treatment of congenital heart disease,” says Dr. Hijazi. “He launched our specialty years ago, and those of us who have followed in his footsteps owe everything to him.” Charles E. Mullins, M.D., FSCAI Dr. Mullins began his 45-year career in the Army, where as early as 1961 he chose to focus on pediatric cardiology, a other purposes, Dr. Mullins stressed the importance of specialty that was not yet formally recognized. He persuading the Food and Drug Administration to revise trained in the adult cardiology program at Walter its approval process to allow access to more devices for Reed General Hospital at a time when cardiac treating congenital heart disease. catheterization was performed primarily for the Most of today’s pediatric procedures are still performed diagnosis of congenital heart disease. “I came into off-label. Although children continue to benefit from cardiology just at the right time, and it suited me advances in adult stent design, investigational devices perfectly,” says Dr. Mullins. designed specifically for pediatric patients have the After a successful career in the Army as the potential to save lives every day. Army’s first pediatric cardiologist and later the only Throughout his career, Dr. Mullins worked to pediatric cardiologist for U.S. forces in Europe, Dr. improve stents and the outcomes of his patients. The Mullins spent the next 37 years at Texas Children’s newly established Mullins Lecture will continue to Hospital where he built a reputation as an innovator, support that work by providing a platform for other not only in developing devices for pediatric use leaders in the field to share their experience, knowledge, but also in leading groundbreaking clinical and and vision for the life-saving stents and procedures of laboratory research and in training future generations the future. of pediatric cardiologists. Stay tuned—SCAI will soon announce who will Dr. Mullins retired in 2006, but his continued deliver the next Mullins Lecture, which will be given commitment and vision for the field was evident in during the 33rd Annual Scientific Sessions, to be held his lecture at the meeting: “Stents: Development and May 5–8, 2010, in San Diego, CA. n

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SCAI’s Sones Awards Honor Distinguished Members Dr. Jack Vogel: At the Helm of Snowmass Conference for 40 Years

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ohn “Jack” H.K. Vogel, M.D., FSCAI, of Santa Barbara remembers the exact moment when he came up with the idea for what would become the Annual Cardiovascular Conference at Snowmass. It was 1969. He was a busy teacher, researcher, and practitioner. And he was a divorced father of three who attributed his marriage’s failure in part to his hectic schedule. “While sitting in my office in the cath lab at the University of Colorado Medical Center,” Dr. Vogel remembers, “I suddenly had an inspiration: to do a family meeting.” That inspiration grew into the Cardiovascular Conference at Snowmass, which celebrated its 40th anniversary last January. In May, SCAI gave Dr. Vogel its F. Mason Sones, Jr., Award for Distinguished Service, the Society’s highest honor. “Jack Vogel is recognized for his important contributions in medical education,” says SCAI Past President Spencer B. King, III, M.D., FSCAI, of Atlanta, the meeting’s long-time co-director. “The Snowmass conference has been the focal point for many practitioners to update themselves on topics of importance to their practice.” Robert A. Vogel, M.D., of Baltimore, is a longtime Snowmass speaker. Dr. Vogel (no relation to Jack Vogel) hasn’t missed a Snowmass conference since he first attended in 1973. “It’s an extraordinary meeting,”

he says. For one, the conference has given him a way to keep up with cardiology’s cutting edge. With a typical attendance of 400–500 people, he adds, the scale was intimate enough to allow plenty of informal interaction between speakers and participants. “It set the standard for continuing medical education,” he says. By honoring Dr. Vogel with the F. Mason Sones Award for Distinguished Service, SCAI also recognized Dr. Vogel’s participation in founding the society more than 30 years ago. When Drs. F. Mason Sones and Melvin Judkins gathered together the small group of cardiologists who became the Society’s first fellows, Dr. Vogel was among them. n

Dr. Michael J. Cowley: A Perfectionist Who Helped Establish a Specialty

“A tireless worker!” That’s how SCAI Past President Bonnie H. Weiner, M.D., MBA, MSEC, FSCAI, describes her colleague and friend Michael J. Cowley, M.D., FSCAI, who received the F. Mason Sones, Jr., Distinguished Service Award at SCAI’s Annual Scientific Sessions in Las Vegas in May. SCAI’s highest honor, the annual Sones Award recognizes Fellows for their work on behalf of the Society, the cardiovascular profession, and patients. “Dr. Cowley is a true leader in Interventional Cardiology,” says Dr. Weiner, who has known him for decades. “Mike is just a wonderful individual who has been dedicated to Interventional Cardiology for his entire life. He has been in the field from nearly the beginning, before there really was something called Interventional Cardiology.” One of the first physicians to travel to Zurich in the late 1970s and learn directly from Dr. Andreas Gruentzig how to perform balloon angioplasty from its inventor, Dr. Cowley went on to become known among the interventional cardiology fellows he trained as “the Master of Threads.” “Mike is amazing with his hands and he’s a perfectionist,” says J. Jeffrey Marshall, M.D., FSCAI, who is one of many interventionalists trained by Dr. Cowley. “One of his first fellows, Dr. Germano At the SCAI Annual Scientific Sessions in Las Vegas this year, the Society presented Drs. Vogel (left) Discascio, nicknamed Mike the and Cowley (right) with its highest honor, the F. Mason Sones, Jr., Award for Distinguished Service. Master of Threads because he


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perfected his skills to the point that he didn’t need a steering device to manipulate the guidewire. He taught fellows that the feel of the wire was important in maneuvering it through tortuous coronaries or through total occlusions. His skill set is what we all should aspire to.” Affectionate nicknames aside, Dr. Marshall also thinks of his mentor in terms of his passion and commitment to furthering a field that has helped so many patients. He recalls: “Back in the early ’80s, when angioplasty was in its infancy, there was a limited number of guide catheters and balloons, so Mike and his partner, Dr. George Vetrovec, would travel up and down Interstate 95 so they could share equipment with Dr. Kenneth Kent at Georgetown. They logged hundreds of highway miles to make sure their patients were able to get state-of-the-art care.” Dr. Cowley served as the Society’s president in 2004–05. He also chaired SCAI’s Interventional

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Committee for years and continues to spearhead many of the Society’s regional education activities. He supported many of the Society’s initial efforts in the area of carotid artery disease education and serves on the Editorial Board of www.Seconds-Count.org, SCAI’s public-education web site. “Mike has been dedicated to acting on opportunities to move SCAI forward,” adds Dr. Weiner. Dr. Cowley has spent most of his medical career at the Medical College of Virginia, part of Virginia Commonwealth University in Richmond. He joined the faculty in 1977, becoming a full professor in 1986. “One of the things he’s best known for is being an educator, engaging younger individuals and teaching them the skills and behaviors necessary to be an interventional cardiologist,” said Dr. Weiner. Also well-known as a researcher, Dr. Cowley has authored or co-authored more than 150 papers, 265 abstracts, and 17 book chapters. n

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Fellows Take on Tough Complications at SCAI’s C3 Summit

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ore than 100 interventional cardiology fellows-in-training attended the Sixth Annual Interventional Fellows Complex Coronary Complications (C3) Summit this year. The educational program, held during the Society’s 2009 Annual Scientific Sessions in Las Vegas, NV, again provided a unique forum for fellows in their final year of training to present and discuss some of the most challenging cases facing interventionalists today. The C3 Summit has become one of SCAI’s “true gems,” said Program Committee Ted Feldman, M.D., FSCAI. “The C3 Summit collects the most interesting and instructive cases from all the training programs in the United States from the prior year. This results in a remarkable collection of captivating and surprising examples of problem solving, great saves, dramatic mishaps, and thoughtful interventional approaches. The ‘wow’ factor keeps growing as each case tops the last.” SCAI Past President Jeffrey J. Popma, M.D., FSCAI, has directed the program since its inception. In the weeks leading up to the C3 Summit, fellows submitted their cases to Dr. Popma, who personally selected the 25 that were presented by the fellows during the program. Then, Jeffrey J. Popma, M.D. in Las Vegas, the fellows attending FSCAI the program and a faculty of experts discussed and dissected each case—looking at how the

complications showcased in each case developed, how they might have been prevented, and strategies for tackling such challenges in the future. “That’s the goal of the C3 Summit—to prepare graduating fellows for the more difficult complications they will face and to illustrate how they might avoid complications in the first place,” said Dr. Popma. Based on participant evaluation, each year the top three cases are selected to receive cash awards plus plaques noting the excellence of their presentations. The winners of this year’s competition were as follows: • First Place: Gerard Connors, M.D., of Stony Brook University Hospital, for his case, “Double, Double Coil and Trouble”; • Second Place: Reza Nazari, M.D., of Albert Einstein College of Medicine, Montefiore Medical Center, for his case, “Lightning Strikes x 3”; and • Third Place: Kyle Smith, M.D., FSCAI, of Scott & White Memorial Hospital, for his case, “Winding Road Ahead.” The Annual Interventional Fellows Complex Coronary Complications (C3) Summit was supported by a generous educational grant from the Cordis Cardiac & Vascular Institute (CCVI). For more information about eligibility to attend next year’s C3 Summit, which will be held during SCAI’s 33rd Annual Scientific Sessions in San Diego, May 5–8, 2010, visit www.SCAI.org. n


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SCAI Spotlight on Early Career If I Knew Then What I Know Now… In an effort to collect pearls of wisdom for earlycareer interventionalists, the Society’s Interventional Career Development Committee recently quizzed several of SCAI’s more senior members about the most important non-clinical lessons they’ve learned along the way to success. “Our committee realized that we have the best possible source of early-career advice here in the ranks of our own membership,” said Paul McMullan, Jr., M.D. He and other members of the committee asked a number of SCAI leaders to share what they wish they had Paul McMullan, Jr., M.D. known at the early stages of their own careers.

Find Your Passion First, everyone agreed an important key to success is to discover your interests and pursue them. “Maximize your opportunity to do the things you enjoy—teaching, writing, or just doing cases,” said Catheterization and Cardiovascular Interventions Christopher J. White, M.D., FSCAI Editor-in-Chief and SCAI Secretary Christopher J. White, M.D., FSCAI. “Don’t let income or location seduce you into taking the wrong job, a job you will regret every day of your working life.” Put Patients First “If you put your patients first, your practice will grow.” This point came up several times, from almost all the SCAI leaders interviewed. “It’s no coincidence that the core mission of almost every medical society, including of course SCAI, is Bonnie Weiner, M.D., MBA, MSEC, FSCAI improving patient care. My feeling is that it should be the core value for every doctor. And success will flow from that value,” said SCAI Past President Bonnie Weiner, M.D., MBA, MSEC, FSCAI. “Seeing patients at their worst, particularly the younger ones, and then seeing them do well for decades after that has been the most rewarding aspect of my career,” she added. “Knowing that without what we do, they would have died at early ages or been severely limited—that’s a powerful motivator.” David O. Williams, M.D., FSCAI, also emphasized patient care: “As an interventional cardiologist you have the power to make an enormous change in a patient’s

life; but you also have a responsibility to always keep the patient’s best interest—rather than your own curiosity or ego—in mind.”

Connect With Mentors “Mentorship is also extremely important,” said Ted Bass, M.D., FSCAI. “It’s one of the best ways to learn, so it’s worth pursuing beyond your immediate community or practice. SCAI’s new mentorship program is a good way to find a highquality mentor.” Ted Bass, M.D., FSCAI Dr. Weiner agreed, “One of the benefits of being involved in the Society is that working with other members gives you the opportunity to find that person with whom you can relate and build a relationship. Then you will be comfortable reaching out to them for advice.” For more information on how you can sign up for SCAI’s mentoring network, email Laura Brown at lbrown@scai.org Make Time for Training “Nothing stays the same in medicine—change is the rule, not the exception,” stressed Dr. White. “Make time for reading and attend both general cardiology and interventional cardiology meetings, so that you can anticipate changes.” Dr. White also recommended viewing coronary artery disease as a core competency, then selectively picking additional areas that your case volume will support and concentrating on that. “This is best done in a group setting, where all the bases can be covered,” he explained. “Remember, you will be known for the quality of work that you perform.” Write and Publish Writing and publishing as much as possible is especially important for physicians in the academic world, emphasized SCAI Past President Morton J. Kern, M.D., FSCAI. “Be as productive as possible and seek as much feedback as you can from senior authors. Morton J. Kern, M.D., “The things that make people pay FSCAI attention are those that are put into print,” said Dr. Kern. “Although it’s a very old story, it’s still a very true story—the more you write and the more you get published, the more people will hear what you have to say. If they see your case report in print, then you become an immediate short-term expert.”


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Tie It All Together at SCAI Getting involved in SCAI can help you find your interests and others who share those interests. Dr. Kern described his first SCAI meeting: “I didn’t know what SCAI was, but once I got there and met some senior cardiologists, I realized I was in the company of some really great, like-minded people I could talk to now because I was on their committee. “Delve as deeply and passionately as you can into every activity, because you don’t know where it could lead. It might lead to a great opportunity.” “Facilitating great opportunities is a major

goal of the Interventional Career Development Committee,” said Immad Sadiq, M.D., FSCAI. “If the committee can help members just starting out on interventional careers to connect with members like those we talked to for this article, then everyone benefits.” Immad Sadiq, M.D., If you are interested in joining the FSCAI committee or finding out how you can get more involved, email lbrown@scai.org. n

SCAI Welcomes New Trustees SCAI is pleased to welcome the following Fellows to the Board of Trustees or the Executive Commitee:

SCAI also thanks the following Fellows whose terms as Trustees or Executive Committee members ended in May 2009. Their service to the Society is gratefully acknowledged:

Alexander Abizaid, M.D., FSCAI Sao Paulo, Brazil

James C. Blankenship, M.D., FSCAI Danville, PA

Lee N. Benson, M.D., FSCAI Toronto, Ontario, Canada

Tyrone J. Collins, M.D., FSCAI New Orleans, LA

Marco A. Costa, M.D., Ph.D., FSCAI Cleveland, OH

Kirk N. Garratt, M.D., FSCAI New York City, NY

Kenneth Rosenfield, M.D., FSCAI Boston, MA

No photo available

Runlin Gao, M.D., FSCAI Beijing, China

James A. Goldstein, M.D., FSCAI Royal Oak, MI

Issam D. Moussa, M.D., FSCAI New York City, NY

Junbo Ge, M.D., FSCAI Shanghai, China

Michael J. Lim, M.D., FSCAI St. Louis, MO

Kimberly A. Skelding, M.D., FSCAI Danville, PA

Zoltan G. Turi, M.D., FSCAI Camden, NJ

Christopher J. White, M.D., FSCAI Secretary, SCAI New Orleans, LA

Carlos E. Ruiz, M.D., Ph.D., FSCAI New York City, NY

Bonnie H. Weiner, M.D., MSEC, MBA, FSCAI Past President, SCAI Worcester, MA


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In the Trenches Cardiologist Translates Interventional Experience and Latest Research Into Best Local Care

F

or nearly 12 years, Xavier E. Prida, M.D., FSCAI, has served the Tampa Bay, FL, community as an interventional cardiologist with the Bay Heart Group, a comprehensive cardiac care provider. Dr. Prida, six other interventional cardiologists, and one electrophysiologist form this group who, according to their website, bring “the latest technological advances in the treatments of heart disease and arrhythmias” to their patients. “We’ve done an admirable job of upholding a community standard of delivery of cardiovascular care, particularly acute care,” says Dr. Prida. The group’s “collaborative, quasi-academic approach mimics what goes on in academic centers.” By working with one hospital, St. Joseph’s, in “a cooperative, collaborative The cath lab is where you test a hypothesis, says Dr. Prida. It’s also the site of his “proudest achievement” -- reperfusing of STEMI. fashion,” they’ve brought “the modern era of treatment of patients with acute myocardial infarction” to their region and made the Nature of Practice These days Dr. Prida spends his time working in reperfusion strategy of patients with ST-elevation myocardial infarction their “flagship service delivery.” the cath lab, seeing patients, and staying up-to-date on the latest developments in the field. Other than Florida Is Home his family, which includes three adult children, he Dr. Prida was born and raised in Florida, where he describes his work as his “adult avocation.” Although attended the University of Florida as an undergraduate he does jog, it’s not just for recreation. It keeps him and the University of Miami for medical school. He in shape, maintains his overall and cardiovascular spent some time in the Northeast while training at New health, and increases his endurance in the cath lab. York Hospital Medical Center, but he always planned He splits his time evenly between clinical practice to return to Florida. and interventional cardiology. “That’s the internal Besides being close to home, the University of fabric of me,” says Dr. Prida. “I know there are different Florida had “a proficiency in the science that really perspectives, but I was trained that the catheterization attracted me,” says Dr. Prida. Drs. Richard Conti and laboratory is where you test a hypothesis.” Carl Pepine, both former presidents of the American “A gorilla could do a cardiac catheterization,” he was College of Cardiology, were Dr. Prida’s primary mentors told during training, “but it takes a skilled physician during his cardiovascular training. “In many ways, I’m to apply new information to the data obtained in the an amalgamation of their acumen and clinical skill sets.” lab to appropriately classify and treat the patient. I’ve They were “very progressive, very well-published… tried to maintain that anchor—the clinical practice of really pushing the science and management of coronary cardiology with that interventional emphasis.” artery disease and pulling it into the modern era.” Dr. Prida also stresses the importance of communicating After leaving academia and before joining the with patients. “You’ve got to have an ongoing dialogue Bay Heart Group, Dr. Prida served a transitional year during the catheterization and subsequent to it in terms as Chief Resident in Medicine at Shands Hospital of future planning of other therapies.” at the University of Florida. He was also a junior The activity he looks forward to most and considers faculty member and spent time in the catheterization his “proudest achievement” is reperfusion of STlaboratory mentoring fellows. He appreciates “the elevation myocardial infarction. He views it as “the aggregation and dissemination of knowledge.” pinnacle application of interventional coronary


CME

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From SCAI And partners SCAI-Cosponsored ProgramS

WOMEN IN INTERVENTIONS

SCAI-Sponsored Programs To register for any of these programs, contact Rebecca Teichgraeber at rebeccat@scai.org or 800-992-7224.

2009 SCAI ADULT AND PEDIATRIC FALL FELLOWS COURSES Date: December 7–11, 2009 Location: Las Vegas, NV Directors: Michael J. Cowley, M.D., FSCAI, Bonnie Weiner, M.D., MBA, MSEC, FSCAI, Christopher U. Cates, M.D., FSCAI, and Ziyad M. Hijazi, M.D., MPH, FSCAI For more info: www.SCAI.org

Date: Oct. 15–16, 2009 Sponsor: Medtronic CardioVascular Location: Chicago, IL Directors: Kimberly A. Skelding, M.D., FSCAI, and Patricia Best, M.D. For more info: http://scai.org/drlt1. aspx?Page_ID=5876

HANDS-ON PERIPHERAL VASCULAR CTA LEVEL 2 COURSE Date: Oct. 29–30, 2009 Sponsor: CVCTA Education Location: New Orleans, LA Directors: Tony DeFrance, M.D., Peter Fail, M.D., Robert S. Schwartz M.D., FSCAI, and John Lesser, M.D., FSCAI For more info: www.cvcta.com/pvd.html

procedures,” because of its immediate impact on the acute and long-term health outcomes of his patients. It also gives him an opportunity to do what he likes best: “implementing new knowledge.”

Support From SCAI Dr. Prida looks to SCAI and its Scientific Sessions to “bridge that gap between what is developed and the discourse in the academic milieu to deliver that to the practitioners.” The Society provides “a relevant and informational venue to make sure the checks and balances are there for what I do on a daily basis.” He continues: “The Society became very meaningful to me when interventional cardiology came into play as a well-defined discipline in the mid- to late-90s, particularly with board qualification and certification. It was a focal point for me to ask what is it that is really important in interventional cardiology in terms of delivering care, implementing guidelines and recommendations, and integrating new clinical research in an applied fashion in a community practice.”

INTERVENTIONAL CARDIOVASCULAR EDUCATION (ICE) Date: Dec. 3–5, 2009 Sponsor: Working Group on Hemodynamic and Interventional Cardiology Location: Ioannina City, Greece Directors: Ch. Arampatzis, M.D., J. Iakovou, M.D., A. Manginas, M.D., L. Michalis, M.D., G. Pavlides, M.D., E. Pisimisis, M.D., G. Sianos, M.D., D. Sionis, M.D., and K. Toutouzas, M.D. For more info: www.ice2009.gr

Innovations in Cardiovascular Interventions Date: Dec. 6–8, 2009 Sponsor: Innovations in Cardiovascular Interventions (ICI) Location: Tel Aviv, Israel Directors: Rafael Beyar, M.D., and Chaim Lotan, M.D. For more info: www.congress.co.il/ ici2009

Putting It All Together Just as Tip O’Neill thought of politics as local, Dr. Prida believes the same of medical care. “But you still need population data—that aggregate data to apply to the individual patient,” he says. He looks to the Society’s appropriateness criteria, e-mails, and other communications to “frame issues as they come forth between the Society and others on contemporary issues, bringing balance and counterpoint” to physicians, who like Dr. Prida, are very busy in the trenches. He views treatment not as a snapshot, but as a moving picture. “What comes before is as important as what’s going on now and what may occur in the future. That’s where understanding the clinical research, applying it, and using it to anticipate future modalities or complications of treatment become so important,” he explains. “It allows for the appropriate delivery of one-to-one bedside care from the first clinical presentation through the catheterization or electrophysiology laboratory and beyond.” n


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