The Society for Cardiovascular Angiography and Interventions

www.scai.org March/April2007

In early February, SCAI released to widespread in-ternational support an expert consensus document examining the current and future role of percuta-

neous 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 cardiol-ogists in the United States, we felt it was our responsibility to con-duct an objective evaluation of an increasingly common practice and 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 con-tradiction 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 en-dorsement of PCI without on-site surgical backup. Instead, we are acknowledging that it is being per-formed 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 interven-tional care worldwide.”

Indeed, the consensus document included authors from several countries and has been endorsed by 12 inter-national societies representing interventional cardiolo-gists around the world (see sidebar on p. 2).

The expert consensus document was unveiled

SCAI co-founder Melvin P. Judkins, M.D., FSCAI, probably wouldn’t be surprised, but he would be delighted to see how the sympo-

sium that bears his name has changed over the years, according to Warren K. Laskey, M.D., FSCAI.

“The Judkins Cardiac Imaging Symposium an-chors 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 2)

SCAIWeighsinonPCIWithoutOn-SiteSurgery;FocusIsonQualityStandards

JudkinsCardiacImagingSymposiumtoKickOffAnnualScientificSessions

(continued on page 3)

Gregory J. Dehmer, M.D., FSCAI

CT UPDATE

In response to feedback from members as well as forth-coming 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. Be-tween now and January 2008, the Society will hold the

(continued on page 12)

Tradition Continues

SCAIOffersHands-onTrainingtoHelpInterventionalistsWithCardiacMultidetectorCTAngiographyCertificationRequirements

and publicized at a major telebriefing hosted by Dr. Dehmer on Feb. 5.

Growing TrendThere is no question that the practice of PCI

without on-site surgery is becoming increasingly common. As of February 2007, primary PCI pro-grams without on-site surgical backup were oper-ating in 40 states. Both primary and elective PCI were being performed without on-site surgery in 27 states. Between 2001 and 2004, 39 facilities with-out on-site cardiac surgery submitted PCI data to the ACC-National Cardiovascular Data Registry (ACC-NCDRTT), a number that climbed to 75 in 2005. International data from 39 countries respond-ing 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 econom-ically 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 an-gioplasty, 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 myo-cardial infarction (MI). Restoration of coronary blood flow within the target 90 minutes becomes more chal-lenging if the patient requires transfer to a PCI cen-ter 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 elec-tive 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 maintain-ing 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 pa-tients than there are patients needing elective proce-

dures,” Dr. Dehmer said. “It becomes very hard to sus-tain a program with primary PCI alone.”

RecommendationsThe 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 through-

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PCI-Surgical Backup (continued from page 1)

Asian Pacific Society of Interventional CardiologyBelgian Working Group of Interventional CardiologyBrazilian Society for Interventional CardiologyBritish Cardiovascular Intervention SocietyWorking Group on Interventional Cardiology of the Bulgarian Cardiology SocietyCardiac Society of Australia and New ZealandEgyptian Society of Cardiology Working Group on Interventional CardiologyInterventional Council of the Cardiological Society of IndiaItalian Society of Interventional CardiologyLatvian Society of CardiologyPolish Working Group on Interventional Cardiology of the Polish Cardiology SocietySociedad Venezolana de Cardiología Intervencionista (Venezuelan Society of Interventional Cardiology)

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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:

SCAI News & Highlights is published bimonthly byThe Society for Cardiovascular Angiography and Interventions

2400 N Street, NW, Washington, DC 20037Phone 800-992-7224; Fax 202-375-6837

www.scai.org; info@scai.org

Gregory J. Dehmer, M.D., FSCAIPresident

Morton Kern, M.D., FSCAIEditor-in-Chief

Kathy Boyd DavidManaging Editor

Rick HenegarDirector, Membership

and Meetings

Andrea HickmanPublications & Committee Operations Coordinator

Sarah JonesMembership Coordinator

Terie KingAccounting Manager

Norm LinskyExecutive Director

Wayne PowellSenior Director,

Advocacy and Guidelines

Bea ReyesDirector, Education

Betty SangerSponsorship and

Development

Touch 3Design & Production

Imaging ZonePrinting

33

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 sur-geons, 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 cardiopulmo-nary bypass does not exceed 120 minutes; andCollect appropriate outcomes data and submit them for comparison with state or national

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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

3

technology that’s being brought to the discipline.”The full-day event, which will take place Wednes-

day, 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 innova-tions, 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 vari-ous imaging technologies. Chan-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 Sys-tems in Hamburg, Germany, whom Dr. Laskey calls “probably the smartest person in the world about x-ray tubes,” will give a talk called, “Advances in X-ray Tube Technology: Angiography and MDCT.”

Other presentations will include “Digital Fluoros-copy and Fluorography: A to Z,” “Flat Panel Tech-nology: 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 academ-ic 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 cre-ative clinical applications of the scientific informa-tion presented in the morning sessions. “The after-noon is more free-wheeling,” said Dr. Laskey. “The speakers are people who are well-known in the clini-cal community explaining how to use this informa-tion in real life.”

Neil J. Weissman, M.D., of Georgetown Univer-sity, 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 Univer-sity 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 “Ra-diation Safety: Practical Applications in the Cath Lab,” “Radiographic Contrast Media: Always Some-thing New,” and “Electro-Mechanical Imaging Mo-dalities: 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 affect-ing imaging. Former American College of Cardiol-ogy 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

Judkins Symposium (continued from page 1)

(continued on page 7)

Warren K. Laskey, M.D., FSCAI

�

SCAI’sHemodynamicsSymposiumOffersRareChancetoLearn,orRe-learn,Fundamentals

Last year, Zoltan G. Turi, M.D., FSCAI, was hoping for about 100 attendees at SCAI’s in-augural Hemodynamics Symposium in Chi-

cago. Although he knew there was a very real need for a course that addressed the subtleties of hemody-namics and angiography, he still questioned his own math skills when he counted 266 physicians vying for seats in the crowded room. And, nine hours after he

opened the one-day symposium, people were still standing in the back, eager for more of this course’s unique focus on the fundamentals of diagnostic catheterization.

This year, SCAI has, of course, reserved a much bigger room for the Hemodynamics Symposium, which will be held Wednesday, May 9, in Orlando, FL, again as part of the Society’s Annual Sci-

entific Sessions. The 2006 Hemodynamics Sympo-sium received high praise in the course evaluations, with many attendees commenting on the dearth of continuing medical education (CME) programs on material so basic to the practice of invasive/inter-ventional cardiology.

“We shouldn’t have been so surprised by the tremendous attendance. After all, this course was conceived because there is almost nothing avail-able in the United States for physicians who want to reacquaint themselves with the building blocks of our profession or for fellows who realize they are relying too much on what the computer tells them and too little on their own knowledge of hemody-namics,” said Dr. Turi, who chairs SCAI’s Hemodynam-ics Symposium with Morton J. Kern, M.D., FSCAI.

Dr. Turi tells of a shocking day almost a decade ago when he was asked to recommend a CME course in di-agnostic catheterization for a colleague who had expe-rienced a near-disaster in the cath lab. “I was stunned to see that there was no longer a single program in the United States that taught the fundamentals of diagnostic catheterization. That was precisely what this seasoned cardiologist needed. I simply couldn’t

believe he was alone in needing such a course.” In conversations with several SCAI Past Presi-

dents, he heard echoes of his own concerns about the lack of training today’s fellows receive in hemo-dynamics. “When I was a fellow 25 years ago, we spent the first two years analyzing the subtleties of pressure tracings. Now our fellows rely entirely on the computer for this, and there is an alarming ten-dency for them to parrot whatever the computer says, even if the data make no sense,” said Dr. Turi.

To help today’s interventionalists get back in touch with the basics of their profession, Drs. Turi and Kern have assembled “a faculty of some of the most dedicated teachers in invasive cardiology,” he said. “This is a labor of love because it’s not the glamorous stuff. What it is, is the essential stuff.”

Included in that all-important “stuff” are many real-world examples that will fool physicians who aren’t careful, possibly leading them to make deci-sions that could even harm patients. “Our purpose is not to trick the audience but to show them how to differentiate pathology from artifact,” Dr. Turi explained. “They’ll see severe disease and data that only look like severe disease; data from patients who

need immediate inter-vention versus data from patients who really need medical care only.”

To keep the program fast-paced and fun, the symposium is packed with relatively short talks as well as mini-quizzes and use of an audience-response system that helps attendees with self-assessment.

In addition to getting reacquainted with the

intricacies of hemodynamics, coronary and periph-eral angiography, and structural heart disease, they’ll also acquire something else that’s very important in the interventionalist’s armamentarium, stressed Dr. Turi. “They’ll acquire much more confidence in their decision making and improve their ability to leave the cath lab with a definitive diagnosis. That’s very helpful in deciding whether or not to intervene.”

For more information or to register for SCAI’s 30th Annual Scientific Sessions, call 800-992-7224 or visit www.scai.org. n

Zoltan G. Turi, M.D., FSCAI

“. . .This course was conceived because there is almost nothing

available in the United States for physicians who want to reacquaint themselves with the building blocks of our profession or for fellows who

realize they are relying too much on what the computer tells them

and too little on their own knowledge of hemodynamics.”

–Dr. Turi

��

SCAIBringsStrategies for SuccesstoScientificSessions

SCAI is pleased to offer attendees of the 30th Scientific Sessions in Orlando, FL, unique ac-cess to the long-running and highly regarded

Strategies for Success program. Christopher U. Cates, M.D., FSCAI, who founded the program in the early 1990s, has developed a half-day Highlights of Strategies mini-course that will give SCAI ’07 at-

tendees a taste of Strategies’ signa-ture focus on controversial topics and the high-profile speakers it gathers to tackle them.

“The full Strategies course runs over a three-day period and the presentations are in-depth, with plenty of interaction between speakers who are the decision-makers in health care, and our at-tendees,” explained Dr. Cates. “For

the purposes of the Highlights course, we’re compress-ing the talks and reducing the question-and-answer periods a bit, but we’re sticking to the Strategies formula–which is bringing cardi-ologists together with the people who make the policy decisions in health care.”

The Highlights of Strategies course will be held Fri-day, May 11, from 2:45 to 5:30 p.m. Joining Dr. Cates at the moderators’ table will be Gail R. Wilensky, Ph.D., who headed up the Centers for Medicare and Medicaid Services when it was known as the Health Care Financing Administration, or HCFA. “Dr. Wilensky now advises Congress and the Bush administration on health care issues, so she is going to kick off the lectures with a discussion of one of the biggest advocacy issues throughout the House of Medicine – Medicare and physician reimbursement, specifically what we should expect from the current Congress,” said Dr. Cates.

Following Dr. Wilensky’s presentation will be a panel discussion titled, “Regulatory Fraud and Abuse:

Case Studies From the Office of the Inspector Gener-al and the Department of Justice.” Featured speakers will include attorney Alice G. Gosfield; Lew Morris, Esq., Chief Counsel to the Inspector General; and Jim Sheehan, Esq., Chief Prosecutor of the Civil Di-vision of the U.S. Department of Justice.

The mini-course will also feature a practical, nuts-and-bolts session on compensation and partnership models for cardiovascular practice. Ron Riner, M.D., President of The Riner Group, Inc., will lead this open discussion related to declining physician reim-bursement and pressures placed on physician income distribution in practices. Also discussed will be vari-ous partnership track models for practices and the pros and cons for the different compensation models.

“I’m very excited about this opportunity to bring Strate-gies for Success into the con-text of a national medical meeting,” said Dr. Cates.

“It’s important, in the midst of a lot of information about new technologies and clini-cal issues, to take some time to address the macro issues in health care. Strategies offers a very rare opportunity to do just that.”

For more information or to register for the Sci-entific Sessions, visit www.scai.org or call 800-992-7224. Watch for details on Strategies for Success XVI in June 2008 in the Grand Cayman Islands. n

Christopher Cates, M.D., FSCAI

“I’m very excited about this opportunity

to bring Strategies for Success into the context

of a national medical meeting. It’s important, in the midst of

a lot of information about new technologies and clinical issues,

to take some time to address the macro issues in health care.

Strategies offers a very rare opportunity to do just that.”

–Dr. Cates

TrainingDirectors’Symposium–ForumforDialogueWithDecision-Makers

For the third consecutive year, SCAI will host the an-nual 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 repre-sentatives from “the agencies that make the rules train-ing directors must play by,” said Joseph D. Babb, M.D.,

FSCAI, who has moderated the In-terventional 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 di-rectors attended last year’s sympo-sium, with many taking advantage of the unique opportunity the meet-

ing presents to engage in direct dialogue with repre-sentatives from the Accreditation Council for Gradu-ate Medical Education (ACGME), Residency Review Committee (RRC), American Board of Internal Medi-cine (ABIM), and Educational Commission for For-eign Medical Graduates (ECFMG).

“The fact that representatives from all of these agen-cies 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 in-put and guidance. That’s huge for us as training direc-tors. It empowers us to frame the issues facing our fel-lows, 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 Or-lando, 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 re-spond to the will of the training directors. In other words, if we say, this is what we must have to competently train-ing 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 interven-tions, and why are we requiring fellows in a one-year pro-gram 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 re-quirements 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 Match-ing 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 mumbo-jumbo because there’s a forum for direct interaction, and it’s at SCAI’s Scientific Sessions.” n

Joseph Babb, M.D., FSCAI

7

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 attend-ees to come every year. “Over the course of two, three, four years, repeat attendees do get the full dose,” he ex-plained, 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 Scien-tific Sessions, visit www.scai.org. n

Judkins Symposium (continued from page 3)

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SCAIMembersOnTheMoveHave you moved or changed posi-

tions recently? Do you know anyone who has? Drop us a note, and we’ll let your colleagues know. That’s the pur-pose of “Members on the Move,” our periodic column that spreads the word about members’ activities and accom-plishments. “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 Uni-versity 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 Direc-tor of Cardiology and Cardiovas-cular Services for the Sparks Health System. The new

position has him wearing many hats, including Director of Cardi-ology of the system’s multispecial-ty group and Medical Director of Cardiovascular Services for the af-filiated hospital. He will also over-see 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-qual-ity clinical services as well as edu-cational opportunities and research advances,” he said. “Our program is growing, and we’re looking for high-ly qualified cardiologists who spe-cialize in the interventional, nonin-vasive, and electrophysiology areas.” Dr. Uretsky urges interested SCAI members or their colleagues to con-tact him at buretsky@sparks.org

SBringing interventional car-

diology to rural southern Ohio

Barry F. Uretsky, M.D., FSCAI

SCAIPresidentDiscussesStentsatNewYorkTimesFoundationJournalismInstitute

At the highly regarded New York Times Foun-dation – Markle Foundation Journalism Insti-tute held in February, SCAI President Greg-

ory 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 Red-berg were among a hand-ful of distinguished physi-cians invited to participate in the educational forum. Their talks, together titled “Stinting on Stents: How Payment for New Technol-ogy Gets Wired,” followed lectures by health policy ex-perts Stuart Altman, Ph.D., Herb Pardes, M.D., and Emma Deland about the 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 en-lighten 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 specifi-cally asked to help the journalists understand the clini-cal 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 ex-perience in that it provided a perspective on how journalists process scientific information and develop their stories,” said Dr. Dehmer. “There was tremen-dous 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 learn-ing more about SCAI as the professional society repre-senting invasive and interventional cardiologists.” n

Medical journalists from throughout the United States attended the Institute, where SCAI President Dr. Gregory J. Dehmer discussed how new tech-nologies affect hotly debated issues in health care.

9

is an exciting experience for Heather Horton, M.D., Ph.D., FSCAI. After five years of work at a larger hospital in Pennsylva-nia, 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 com-munity where people had to travel one to two hours to larger metropoli-

tan hospitals for cor-onary angioplasty,” she said. “There is no shortage of cases and the need is just as great, if not great-er, here in the Mid-west as in other parts 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 vas-cular 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 com-munity, 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 di-rector of the Cardiac Cath Lab at Geisinger Wyoming Valley Medi-cal Center in Wilkes-Barre, PA.

SAfter eight years in private

practice, R. David Anderson, M.D., M.S., has joined the Uni-versity 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 re-turn 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 cardiac catheter-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 per-cutaneous 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.

SRichard Stewart, M.D.,

FSCAI, wrote to SCAI about his recent move to Fort Worth, TX, where he is Associate Professor of Medicine/Cardiology and Direc-tor of Endovascular Intervention-

al Medicine at the University of North Texas Health Sci-ence Center as well as Director of the cardiac catheteriza-tion laboratory at John Peter Smith Hospital. Dr. Stew-

art is enjoying being back at an academic medical center.

SIn January, Caritas St. Eliza-

beth’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 Car-diovascular Services. Dr. Popma, a Past President of SCAI, will coordinate and standardize high-quality and integrated invasive cardiovascular services within the Caritas network in collabo-

ration with the catheterization laboratory directors at five com-munity hospitals. “I am humbled by the opportunity to work with our community hospital physician partners in developing standard-ized, evidence-based interven-tional cardiovascular care for our patients,” said Dr. Popma. “Edu-cation and training are critical components of this effort.” He will be the overall director of the Consolidated Car-diac Catheteriza-tion Laboratories, which, he said, will require “embracing the fundamentals – developing close physician relation-ships within the communities we serve; facilitat-ing access to our hospitals for re-ferring physicians, patients, and their families; and providing ter-tiary cardiovascular support for our community hospitals.”

Dr. Popma will also serve as the director of the Caritas Center for Advanced Cardiovas-cular Education and Training, a facility dedicated to training in advanced cardiovascular tech-niques for interventional cardiolo-gists, 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 sim-ulation training will be essential features of this advanced cardio-vascular training effort.” n

Heather Horton, M.D., Ph.D., FSCAI

R. David Anderson, M.D., M.S.

Richard Stewart, M.D., FSCAI

Jeffrey J. Popma, M.D., FSCAI

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In the month following advisory panel hearings held by the Food and Drug Administration on the safety

of drug-eluting stents (DES), SCAI moved swiftly to deliver specific and practical recommendations on the best use of these devices in the care of patients with cardiovascular disease. Leading the effort to draft and distribute the Society’s Clinical Alert was SCAI Past President and DES Writing Committee Chair John McB. Hodgson, M.D., FSCAI. The Clinical Alert was approved by SCAI’s Executive Committee and rapidly moved into the hands of Catheterization and Cardiovascular Interventions Editor-in-Chief Christo-pher J. White, M.D., FSCAI.

“To our knowledge, SCAI was the first professional medical society to publish a Clini-cal Alert on DES following the FDA hearings,” said Dr. Hodgson, who was interviewed by several re-porters and quoted by mainstream media outlets such as U.S. News & World Report, the Associated Press, and The Washington Post, as well as many health care-focused outlets, such as theheart.org, Cath Lab Digest, and HealthDay, among many others. In interviews, Dr. Hodgson stressed the importance of a “back-to-basics” approach in the use of DES, not-ing that new data revealing the rare but undeniably serious occurrence of late-stent thrombosis in a small group of DES patients should remind interventional-ists to “Do a good job, do it in the right people, be sure you look at the whole package, and assess the risks and benefits before you do it.”

The practical steps outlined in the Society’s DES Clinical Alert include the following:

Prior to any stent implantation, patients should meet accepted criteria for coronary intervention as described in the 2005 update of the ACC/AHA/SCAI practice guidelines on percutaneous coronary intervention. The decision to treat a patient with DES —rath-er than a bare metal stent or bypass surgery—must be made on an individual patient basis, considering the relative risks and benefits of each therapy. This determination will vary according to each patient’s medical history, coexisting ill-nesses, 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 implan-tation technique.

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Patients should take dual-antiplatelet medica-tions for at least three to six months, preferably for 12 months unless there is a high risk for bleeding. In patients with a higher-than-average risk for late stent thrombosis—for example, those with diabetes—physicians should consider not only continuing dual-antiplatelet medications for longer than 12 months, but also testing respon-siveness to these medications and adjusting dos-ages as needed. Discontinuation of dual-antiplatelet medica-tions requires careful consideration and must be individualized for each patient.A week after the distribution of SCAI’s Clinical

Alert, Dr. Hodgson found himself addressing questions related to these latter points about the im-portance of antiplatelet therapies for DES patients. The interest fol-lowed from the release of a state-ment by the American Heart Asso-ciation (AHA) and various other medical societies, including SCAI.

Talking With Third-Party Insurers, TooAt press time, Dr. Hodgson was preparing to testify

before the California Technology Assessment Forum, an advisory organization for the Blue Cross/Blue Shield. He has been asked to testify on the safety of DES.

“My goal is to clear up the confusion surrounding the safety of the devices,” he explained. “It’s impor-tant that insurers understand that there are risks and benefits with all therapies, and drug-eluting stents are not an exception. However, when they are used properly, in the right patients, and with the proper follow-up medications, as outlined in SCAI’s Clini-cal Alert, they do a lot of good for a lot of patients with cardiovascular disease.”

SCAI will keep members informed as issues re-lated to DES unfold. Visit www.scai.org often for updates. The Web site also features SCAI’s Clini-cal Alert on DES, the AHA-spearheaded consen-sus document on antiplatelet medications, and Dr. Hodgson’s testimony. n

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SCAIDeliversPracticalGuidanceonUseofDES

“Do a good job, do it in the right people, be sure you look

at the whole package, and assess the risks and benefits before you do it.”

-Dr. Hodgson

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CT Update (continued from page 1)program five times in four cities, including a special one-day mini-course held in conjunction with the 30th Annu-al 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 cardi-ac CT before July 2008, when the recommend-ed training levels for level-II certification will 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 com-fortable with it before that deadline arrives,” stressed Dr. Hodgson, who will co-chair four of the five courses with Dr. Schwartz. “Cardiac CT 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 be-lieve that the Society should play a key role in the train-ing 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 pro-ficiency in this new technology, said Dr. Schwartz. “We have spent our careers focusing on the coronary arter-ies, 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 oth-er courses tend to focus on didactic instruction, with a limited amount of hands-on experience reformatting two-dimensional axial CT slices into three- and four-dimensional 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 di-verse 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 instruc-tion 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 pa-thologies 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 ma-nipulation 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 ana-lyzing cases on the workstations, enrollment is limited. Register early to be sure you get a seat! n

Robert S. Schwartz, M.D., FSCAI

Cardiac CT Angiography–Learning by the CasesApril 2 & 3, 2007, Phoenix AZGE Healthcare Vital Images, Inc. May 12, 2007, Orlando, FLGE Healthcare TeraRecon, Inc.Vital Images, Inc.

June 18 & 19, 2007, San Francisco, CAVital Images, Inc.

September 10 & 11, 2007, Minneapolis, MNTeraRecon, Inc.Vital Images, Inc.

January 10 & 11, 2008, Phoenix, AZTeraRecon, Inc.Vital Images, Inc.

THANK YOUThe 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:

www.scai.org

John McB. Hodgson, M.D., FSCAI

Appreciation is also expressed to the following companies for in-kind support of educational simulators, IVUS, and/or FFR units for the program:Boston Scientifi c CorporationCordis Corporation, a Johnson & Johnson companyMedical Simulation CorporationMenticeAGA Medical CorporationRADI Medical Systems, Inc.Terumo Interventional SystemsVolcano Corporation

PLATINUM SUPPORTER

Boston Scientifi c Corporation

GOLD SUPPORTERS

Cordis, a Johnson & Johnson companyAbbott Vascular/Guidant

SILVER SUPPORTERS

St. Jude MedicalGE HealthcareBristol-Myers Squibb/Sanofi Pharmaceuticals PartnershipDaiichi Sankyo, Inc. and Eli Lilly and Company

BRONZE SUPPORTERSMedtronic VascularAGA Medical CorporationCook Inc.Schering-PloughTerumo Interventional SystemsW. L. Gore and Associates, Inc.PDL BioPharma

THANK YOU

2006 SCAI Interventional Cardiology Fellows CourseNovember 29 – December 2, 2006 • Las Vegas, NV

The Society for Cardiovascular Angiography and Interventions expresses deep appreciation for the generous support from the following companies

SCAI ALSO THANKS:

Abbott Vascular for support of the fellows dinner and fellows workshops

Boston Scientifi c 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

Fall_Fellows_thank_you 1 3/7/07, 9:46:31 AM

FormerInternalMedicinePhysicianFindsHisHeartintheCathLab

IN THE TRENCHES

Flu season was right around the corner when we caught up with former internal medicine doc-

tor Peter Angelopoulos, M.D., FSCAI. Now an in-terventional 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.

Blood Pressure Check, Anyone?

“I always knew I was going to med-ical school—probably from the time I was in junior high,” explained Dr. Angelopoulos. “I remember learn-ing how to take blood pressures and neighbors coming over to the house to have their numbers checked.”

His parents, both from Greece, never had the opportunity to advance their for-mal education because they grew up during World War II and the civil war that followed in Greece. “My father was a butcher by trade and worked up to three jobs to provide for our family. My mother stayed at home to raise the children,” he said. Both of his parents were firm believers in the value of education, and they instilled this belief in their children, but the realities of paying for such instruc-tion posed tough challenges.

The cost of higher education became apparent when Dr. Angelopoulos was accepted into New York Univer-sity’s pre-med program. “Recognizing the cost, I dropped out before starting. I knew my parents could never afford it,” he said. Instead, he turned to Queens College, part of the City University of New York, where he was able to work, first as a bank teller and later as an EMT and para-medic, to pay for his undergraduate schooling.

Finding His NicheDr. Angelopoulos’s paramedics instructor encouraged

him to go to Ross University in Dominica, West Indies, for medical school. It was excellent advice, said Dr. Angelopoulos, for more reasons than one might guess. There he met Gina, an emergency medicine physician-in-training, whom he later married.

After completing his internal medicine residency,

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. An-

gelopoulos knew he had found his niche in life, occurred during the first week of his cardiovascular fellowship, shortly af-ter 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 contrib-uting to something really important. I knew then and there that I was going to become an interventional cardiologist.”

SCAI, Always “On Call”Dr. Angelopoulos first heard about

SCAI after finishing his interventional cardiology fellowship. “Because SCAI is smaller than the other cardiovascular associations, you actually feel part of the

Society. I can always pick up the phone and talk to some-one there on any issue, and they will deal with it immedi-ately. And, through SCAI, you can also phone or e-mail any expert in the interventional field with any questions. I am also thankful to SCAI—and in particular Dr. Chris White—for helping members get reimbursement and training for peripheral interventions.”

Dr. Angelopoulos has recently become involved in the SCAI Interventional Career Development Committee and looks forward to finding ways to help the Society grow.

“That Wonderful Rush”Dr. Angelopoulos is currently busy as part of a group

practice in Garden City, NY. He enjoys the day-to-day life of an interventionalist and is known for his bedside man-ner: he keeps his patients smiling with a steady stream of light-hearted banter. However, for him, it all comes down to what he can accomplish in the cath lab. “There is no greater rush than opening a totally occluded artery and within minutes seeing it wide-open with excellent flow. And the patient actually feels good enough to go home!” he exclaimed. “Or, as another example, when a patient comes for a checkup—after I have opened her iliac arter-ies—and she tells me she can now outwalk her dog.” n

It wasn’t long after setting foot in the cath lab for the first time that Dr. Angelopoulos realized he’d found his niche in life.

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30th ANNUAL SCIENTIFIC SESSIONS MAY 9–12, 2007 • Orlando, Florida

ONLINEwww.scai.org

Questions? Call (800) 992-SCAI

TOTAL AMOUNT $_______________

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