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The Take Home: SCAI
This year’s Society for Cardiovascular Angiography and Interventions Scientific Sessions provided attendees with new information on a variety of trending topics in the field of intervention. Cardiology Today’s Intervention was on-site at the meeting in San Diego, held April 25 to 28, covering the latest clinical updates with perspective from leading interventionalists.
Read on for insights and top takeaways from this year’s meeting, from Cardiology Today’s Intervention Editorial Board Member Lloyd W. Klein, MD, with Rush University Medical Center; Ki Park, MD, with University of Florida, Gainesville; and George W. Vetrovec, MD, MSCAI, with Virginia Commonwealth University Pauley Heart Center.
Women in Interventional Cardiology
Park: A highlight for me was the SCAI-WIN Women in Interventional Cardiology Forum. The forum brought together a group of women from a variety of backgrounds and with varying interests. One highlight was case presentations by women in our field performing very high-level, advanced and innovative coronary and structural cases. It was eye-opening to hear from other women in the field doing these types of cases, from left atrial appendage closure to percutaneous tricuspid valve repair to chronic total occlusions. The forum also featured a lineup of interesting topics from female leaders in interventional cardiology. Bonnie H. Weiner, MD, MSEC, MBA, MSCAI, a past president of SCAI, highlighted the past, present and future of women in interventional cardiology and discussed the importance of financial planning and tips for women in the field. Kimberly A. Skelding, MD, FSCAI, focused on how to work towards work-life balance and gave a logistical talk on the business and functional aspects of opening an outpatient-based cath lab.
The SCAI-WIN forum is also unique in that it featured small group sessions to foster interaction and networking with other attendees. Our small group included academic and private practice faculty and two cardiology fellows who plan to go into interventional cardiology. We discussed different topics pertaining to being a woman in this field, such as family-work balance and also the pros and cons of academic vs. private practice.
The biggest takeaway for me is, if women in our field have the opportunity to attend this, or a similar session, it’s very insightful, great for networking, great to see what other women in our field are doing in their day-to-day practice, and how they are contributing to the present and future of interventional cardiology.
Research Updates
Vetrovec: Overall, there was a sense of enthusiasm and momentum-building at the SCAI meeting. The sessions provided practical nuts and bolts for the interventional community, and I think that is helpful for all attendees.
This year’s meeting featured intriguing data that seemed to generate interest and pave the path for future research. One first-in-human observational study looked at whether treatment of psoriasis with anti-inflammatory therapies would confer favorable coronary characteristics. Eighty-four patients (mean age, 50 years) received anti-tumor necrosis factor agents or interleukin-17 inhibitors, which are FDA-approved biologic treatments for psoriasis, and the rest received topical or ultraviolet light therapies. The researchers then assessed noncalcified burden, plaque volume and maximal artery stenosis using coronary CTA. Biologic therapy decreased plaque volume by 40%. That’s rather dramatic. Anti-inflammatory therapies have gained recent interest in the cardiology field. This new, although small, study opens the door to looking at a new line of therapies for managing coronary disease. What’s interesting is that this study focused primarily on coronary disease regression, whereas other research on biologic therapies were focused more on HF.
Also interesting was the presentation of a subgroup analysis of the PRESERVE trial, which compared IV isotonic sodium bicarbonate with IV isotonic sodium chloride and oral-N-acetylcysteine with placebo in 4,465 high-risk patients after angiographic procedures. The subgroup analysis focused on 1,161 patients with chronic kidney disease who underwent PCI, more than 500 of whom were included in each treatment arm. The primary composite endpoint of death, need for dialysis or persistent kidney impairment occurred in 2.6% of the sodium bicarbonate group, 4% of the sodium chloride group, 3.8% of the oral acetylcysteine group and 2.8% of the placebo group. The differences were not statistically significant. Neither IV sodium bicarbonate nor oral acetylcysteine were superior for reducing serious adverse 90-day events or contrast-associated acute kidney injury. These results suggest that saline loading still remains the established treatment for preventing renal insufficiency at the time of catheterization, with or without pre-existing renal failure.
Practice Issues
Klein: This year’s SCAI Scientific Sessions was a wonderful and worthwhile meeting that highlighted many concerns and issues that we face in clinical practice.
I am particularly interested in — and also concerned about — where interventional cardiology as a field is headed in terms of quality, value and reimbursement. So, I was especially interested in the sessions on the appropriate use criteria and public reporting. The session on the appropriate use criteria, which was moderated by Lyndon C. Box, MD, FSCAI, and Sunil V. Rao, MD, FSCAI, FACC, was excellent and shed light on some of the challenges that interventional cardiologists face regarding case selection. Although good general advice, many cardiologists sometimes do not find the appropriate use criteria to be a useful guide in their practice in individual patients; more often, they seem to be an obstacle to overcome in order to provide what we perceive to be optimal care. Although the appropriate use criteria provide a valuable broad overview of the evidence base, occasionally best practice depends on fine-tuning, centered on details of the individual patient. The unfortunate consequence is that it can be difficult to assess when a treatment decision could be improved vs. when it is the right decision in an exceptional situation. Moreover, the technical facets of intervention are progressing more rapidly than reflected in published clinical trials; therefore, the acute problem that patients present with can be managed and patients discharged safely, but perhaps with incremental risk for later problems. We have no way to evaluate when what is safest in the acute situation might be a better choice than what provides the best long-term outcomes. As a reaction to this complex situation, some cardiologists do not feel that benchmarking their results through participation in registries or reporting them publicly accurately reflects their quality, and they may have a point; then we have to ask what will be the future of physician-led registries in this environment? If we do not police ourselves, outside agencies with little insight into these problems might impose standards based on financial considerations alone.
The session on occupational hazards, which I chaired, was also a great session. One of the newer issues about which I spoke was whether or not interventional cardiologists have an increased risk for CAD due to radiation exposure. There are currently no clinical studies specifically looking at this problem, but we do have a background of basic science findings showing that cardiologists and radiologists who are exposed to radiation have more increased carotid intimal-media thickness, suggesting increased atherosclerotic risk. I discussed proven effects on telomere length and damage to DNA. So, while we do not yet have a clinical study addressing this particular problem, the basic science findings strongly suggest that my generation of interventional cardiologists may be at increased risk for developing the very disease that we’re treating.
Disclosures: Klein, Park and Vetrovec report no relevant financial disclosures.