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The Take Home: SCAI
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In May, the interventional community descended on New Orleans to share their knowledge and expertise and hear the latest in education and medical advances at the annual Society for Cardiovascular Angiography and Interventions Scientific Sessions. The Scientific Sessions this year comprised six tracks — coronary, congenital, peripheral, structural, C3 Summit for Fellows and Cath Lab Boot Camp. The 2017 meeting marked the 40th anniversary of SCAI, and the society held a special “40 for 40 Session” featuring iconic figures in interventional cardiology over the years.
Commenting to Cardiology Today’s Intervention on the take-home messages from the Scientific Sessions were SCAI 2017-2018 president Kirk N. Garratt, MD, MSc, FSCAI, from Christiana Hospital, Delaware; and George W. Vetrovec, MD, MSCAI, from Virginia Commonwealth University Pauley Heart Center.
FOCUS ON LIVE CASES
Garratt: Incorporation of live cases at SCAI 2017 was a big hit. It is difficult to know how valuable cases are for learning. Sometimes you walk away from a live case and there’s no doubt you’ve seen something that you will take home and use, but other times that’s not the case. A goal of SCAI is to provide education that an interventional cardiologist can put in his pocket, carry home and use next week in practice. So we tried to select cases that were aligned with that philosophy. We tried to show real cases that are representative of the challenges that our membership faces in the cath lab every day, and then show solutions.
EARLY CAREER ATTENDANCE
Garratt: One of the visits I really enjoyed was with the new group of SCAI Emerging Leader Mentorship (ELM) candidates. The ELM program comprises a group of up-and-coming physicians and facilitates their transition as the next generation of great thinkers, presenters, teachers and national leaders. Those chosen for the ELM program participate in six training sessions over 2 years and will be assigned a panel of mentors specifically chosen to match their interests and aspirations.
To have an opportunity to meet with the early career interventionalists and talk with them about what they’re doing, where their vision lies and what they’re excited about doing was incredible. The ELM program is meant to provide added benefit, support and energy to people who are already on their way to success. It is clear that the innovative spirit in intervention will continue with this new generation of leaders.
OCCUPATIONAL HAZARDS IN THE CATH LAB
Vetrovec: I attended an interesting session on occupational hazards in the cath lab, with talks on radiation safety and minimizing risk; orthopedic injuries; robotic technologies; and more. James A. Goldstein, MD, FSCAI, discussed how to manage stress, fatigue and burnout in the cath lab, and I gave a talk on operator retirement. This was a practical session that focused on topics that aren’t always discussed in an open format. It’s a very personal thing when you decide when to retire. People are challenged by this because work is often considered their identity, and many are anxious to keep doing “something.” One of the points I tried to convey is that there are many opportunities to remain active and “contribute” beyond just practicing intense, full-time medicine. Examples include, limited clinical practice, often in volunteer rural or “free” clinics; part-time teaching; or medical consulting. There are physicians who have written books or novels in retirement. The good thing about retirement is it affords the chance to focus on opportunities that the individual finds fun and rewarding.
40 YEARS OF ADVANCES
Vetrovec: I participated in the “40 For 40 Session” celebrating the 40th anniversary of SCAI and coronary angioplasty. [Other “luminaries” on the stage included Joseph D. Babb, MD, MSCAI; Spencer B. King, MD, FSCAI; Harry L. Page, MD, FSCAI; and Bonnie H. Weiner, MD, MSEC, MBA, MSCAI, among others.]
I wasn’t at the very first meeting of SCAI — then called The Society for Cardiac Angiography (SCA) — but became involved soon after and later served as president of the society in 1993-1994. The idea for the society came about because the founders wanted to define quality and support efforts to achieve that level of outcome for procedures, as there were concerns that some labs may not have been performing safe and high-quality procedures. At that time, there really weren’t any other societies dedicated solely to intervention.
SCAI started off as a very small meeting but soon expanded. Sitting on the stage with the other “luminaries,” we reflected on the origins of coronary angioplasty; innovations, techniques and initiatives that have improved patient outcomes over the years; and the role of SCAI in advancing the field then, now and in the future. It really is remarkable — just from a technical standpoint — how far we have come. The contrast used is better, the catheters are smaller and patient outcomes are drastically improved. We have improved, as a field, over the past 4 decades. Coronary angioplasty has now become a very straightforward procedure with minimal risk and limitations. More recently, intervention has expanded beyond only coronary procedures to structural and peripheral, as well.
However, moving forward, challenges do remain, as we discussed during the panel session — for example, complete revascularization and excellence in lesion quality. Another persistent challenge is determining which patients do better with intervention vs. surgery.
Garratt: The “40 For 40 Session” was a special event. We had at the podium the people who contributed to the launch of the entire science and the folks who were involved in milestone development in interventional work. As we discussed in that session, the great thing about having a mature discipline is that our work is simplified by being focused on those things that we know really work well. Of course, this means that we have had to set aside those things that just didn’t work quite as well as our everyday devices for interventionalists. Very clever engineering and creative thinking has gone into the innovative tools that we were privileged to test over the years.
The important take-away from this session is that the spirit of innovation has fed interventional cardiology in an incredibly important way. One of the things we want to impress on incoming fellows and early career SCAI members is the importance of maintaining that innovative energy — not being satisfied with the great results we get today because it’s a certainty that there are undiscovered methods and techniques and developments that will make therapies even more effective and safe and in the future.
LOOKING FORWARD
Garratt: One of the things I would like to focus more on is leveraging technologies outside of the cath lab that complement and serve our practice inside the lab. For example, the SCAI-QIT Appropriate Use Criteria app for diagnostic catheterization and coronary revascularization, which we use in our cath lab. Beyond that, there are many other technological opportunities to work toward to get better control of patients ahead of time, and to keep in contact with out patients to guide their decision making and care once they leave the hospital.
Disclosure: Garratt and Vetrovec report no relevant financial disclosures.