www.scai.org www.seconds-count.org January/February 2010

The Society for Cardiovascular Angiography and Interventions

Geoffrey Hartzler, M.D., was an interventional cardiologist before the subspecialty existed. In May he will deliver the Founders’

Lecture at the SCAI 2010 Scientific Sessions, tracing the early days of coronary intervention and offering a historical perspective on the profession he helped birth.

(continued on page 6)

SCAI is working behind the scenes to reshape worrisome provisions of a proposed quality measure that would track 30-day, all-cause readmissions following PCI among

Medicare patients. The hospital-level measure, which could provide important clues to explain wide variations in PCI readmission rates, has raised concern among interventional cardiologists, who say it casts too wide a net to identify preventable readmissions.

“SCAI is fully supportive of quality of care and cost containment. The positive impact of quality initiatives on patient care can’t be overestimated,” said Charles E. Chambers, M.D., FSCAI, director of the cardiac catheterization laboratory at Penn State Hershey Medical Center in Hershey, PA, and a member of the working group that

participated in the development of the quality measure. “The problem is that this measure is not specific enough. As a result, it could end up penalizing interventional cardiologists who take care of the sickest patients.”

The PCI readmission measure was developed by Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) for the Centers for Medicare and Medicaid Services (CMS). It uses data from the American College of Cardiology’s NCDR CathPCI Registry® for risk adjustment and links to Medicare Part A inpatient and outpatient administrative claims data to document readmissions. As proposed, the measure would tabulate readmissions for any cause—with the exception of staged coronary procedures—within 30 days of PCI.

It’s understandable that PCI readmissions caught the attention of CMS at a time when the federal agency is

SCAI Urges Significant Revisions to PCI Readmission Measure

(continued on page 4)Charles E. Chambers, M.D., FSCAI

Dr. Geoffrey Hartzler to Recount Early Days of Angioplasty in 2010 Founders’ Lecture

Mullins Lecture Highlights Advances in Pediatric Stenting

John W. Moore, M.D., MPH, FSCAI, will deliver the Mullins Lecture at the SCAI 2010 Scientific Sessions in a presentation that will focus on

the past, present, and future of stent treatment for congenital heart disease.

The keynote lecture was named in honor of Charles E. Mullins, M.D., FSCAI, who pioneered the use of stenting and other interventional procedures in pediatric cardiology and continues to be very active in SCAI.

(continued on page 6)

SCAI 2010

NEWS

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This fall, SCAI welcomed more than 150 physicians of various specialties, nurses and technicians, business leaders, and patients to a

special educational event on a topic of importance to everyone in the United States: healthcare reform. The first-of-its-kind event paired SCAI with Pittsburgh’s Allegheny General Hospital as hosts for an in-depth look at the tremendous progress made in cardiovascular care since 1960, and where plans for healthcare reform might lead the specialty.

The event — a new twist on SCAI’s series of Know What Counts regional education programs — brought together a cadre of speakers as diverse as the audience. U.S. Representatives Jason Altmire (D-PA) and Tim Murphy (R-PA) were joined by local health journalists, patients, and physicians. Program Director Tony Farah, M.D., FSCAI, chief medical officer and medical director of the cardiac catheterization laboratories at Allegheny General Hospital, moderated the event with Arthur Feldman, M.D., chair of the Department of Medicine at Thomas Jefferson University in Philadelphia.

“Past Know What Counts events have been focused on providing education on clinical topics to general

cardiologists, internists, family physicians, and other primary care providers,” explained Dr. Farah. “One of our goals for the event in Pittsburgh was to engage the wider medical community and the public in an educational discussion about a topic that could have a tremendous impact on how cardiovascular care is delivered in the future.

“We also wanted to raise awareness of the progress the cardiovascular specialty has made and the impact of interventional cardiology therapies, and also encourage people to participate in the debate about healthcare reform,” Dr. Farah adds. “I’m very proud that SCAI and Allegheny General Hospital created a platform and brought legislators who are shaping the reform bills, doctors, patients, and the press to the same stage just when the new healthcare legislation was under debate in the House.”

Joining the DebateGetting involved was an important theme, one

both Congressmen urged. Representative Murphy polled the audience, asking how many attendees had communicated their concerns about healthcare reform to their elected representatives. “I can’t address a letter that never gets sent,” he stressed.

In program evaluations, attendees reported that the message got through. “I felt energized by this program,” wrote one participant. “Instead of complaining about the proposed healthcare reform in Congress, we actually can do something about it by making our voices heard.”

Another attendee vowed to tell everyone she knows to write to their Representatives. Her message to Congress may resemble that delivered by Dr. Feldman, whose presentation, “Ten Things I Hate About Healthcare Reform,” resonated with many attendees. “Our healthcare system needs to be changed so that all of my patients, and all citizens, have access to the care they need. But I don’t agree with how Congress is going about it,” he said, before outlining grave concerns about reimbursement cuts for cardiology services provided to Medicare beneficiaries, the pending shortage of healthcare providers, misguided financial analysis on the impact of preventive care, and the need for tort reform, among others.

Funding for research must be preserved, stressed Drs. Feldman and Farah. “Forty years ago, a heart attack victim who made it to the hospital was given painkillers and oxygen and then sent home. The total cost on average was $5,700. Today, if you suffer a heart attack and make it to the hospital for treatment, you have a 94 percent chance of survival. That’s a direct result of investing in innovation. We have angioplasty, stents, and clot-busting drugs, just to name a few, but

SCAI Hosts Public Education Event on Healthcare Reform

SCAI Thanks...

SCAI has undertaken the Know What Counts public education initiative with its own resources as well as support from Abbott Vascular, Boston Scientific

Corporation, Cordis Corporation, and Medtronic CardioVascular. The Society gratefully acknowledges this

support while taking sole responsibility for all content developed and disseminated through the effort.

Education

With the Know What Counts event that he directed, Dr. Farah created a platform that brought health care providers, patients, journalists, and policymakers to the same stage.

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33

it comes at a cost – about $54,400 per patient,” said Dr. Farah.

“It’s true,” he continued, “we have come to an important crossroads where we must determine how to continue investing in innovation, while at the same time identifying ways to contain costs. We can’t take a chance on ruining what we’ve accomplished. It’s our patients who will suffer most if we do.”

Dr. Farah’s point hit home for many attendees when two of his patients took to the stage. Forty-one-year-old Amy Wolbert moved many in the audience to tears when she retold how a sudden heart attack led to sudden cardiac arrest and very nearly left her daughter motherless. First, her colleagues saved her life with an AED, she said, and then Dr. Farah saved her again, with emergency balloon angioplasty and stenting.

“I knew I should eat better and get more exercise,” she exclaimed, “but I never thought something like this could happen to me.”

But it did, and Dr. Farah showed the audience the angiographic evidence of what had happened to Ms. Wolbert, and how medical innovation had opened her severely blocked arteries.

Also in his forties, patient Marty Kelly described the debilitating symptoms he was suffering in the months leading up to undergoing PCI: “Before I was treated, I could barely walk 100 yards or lift anything into the trunk of my car without gasping for breath. Just normal, everyday tasks were exhausting. Now, I’ve never felt better. I feel like I’m 20 years old again.”

“The patients, more than anyone else on the stage, helped people understand what interventional cardiologists do and the importance of keeping that knowledge in mind when making critical decisions about healthcare reform,” said Dr. Farah.

A Model for the Future Months after the program, people in Pittsburgh were

still talking about it, reported Dr. Farah. “The president of our local medical society, a primary care physician, came to me after and said, ‘If you do anything like this in the future, I’ll be happy to sponsor it with you.’”

Dr. Farah is hopeful that there will be more events in other communities around the country like the one held in Pittsburgh. “SCAI’s Know What Counts could go a long way toward painting a more accurate picture of advances in interventional care,” he said.

In fact, that was another of Dr. Farah’s goals – to attract the interest of local health writers. He invited two local journalists, Luis Fabregas from the Pittsburgh Tribune Review and Mark Roth from the Pittsburgh Post-Gazette, to participate in a panel discussion of how the media covers healthcare.

“Their presence achieved two aims. First, I think it helped attendees gain a better understanding of the challenges of delivering up-to-date, unbiased information on trials, but it also showed the writers, most effectively with the patient testimonials, what we do and why we do it. Next time, they’re covering a trial like COURAGE, maybe they’ll try a little harder to get the interventionalists’ side of the story,” he said. “Maybe they’ll call SCAI.”

For more information about SCAI’s Know What Counts programs, contact Kathy Boyd David at kbdavid@scai.org. n

AlSo In PITTSburgh …

The Know What Counts program in Pittsburgh also featured a dinner symposium for health professionals. Nearly 30 internists, family physicians, general cardiologists, and nurses involved in the care of interventional patients attended the program at a local restaurant. In his presentation “Coronary Artery Disease: Right Patient, Right Treatment,” Dr. Farah reviewed the latest clinical trial findings on the various therapeutic options for heart disease patients. Dr. Feldman’s discussion, titled “Is It Time for Personalized Medicine?” examined how strides currently being made in genomic medicine may help guide physicians in the delivery of treatments tailored to individual patients.

Both topics stimulated discussion among the group. The well-received program received high marks from attendees, including one general cardiologist who remarked, “You know, I thought I already knew all that stuff about the trials, but I learned a lot I didn’t realize I didn’t know.”

The Know What Counts program was held just days after CMS announced its Final Rule for 2010, including dramatic cuts for cardiology reimbursement. Dr. Feldman hammered home the ramifications of cutting physicians’ fees for patients and the health care system.

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4

exploring ways to reduce hospital readmissions overall. PCI is one of the most commonly performed cardiac procedures in the United States, accounting for over 1 million procedures annually. A retrospective analysis by Curtis et al., published in the September 1 issue of the Journal of the American College of Cardiology, found that among Medicare patients, 30-day PCI readmission rates, including staged procedures, averaged 14.6 percent, with a median that ranged from 8.9 percent in the lowest decile of hospitals to 22 percent in the highest decile.

SCAI’s primary concern with the PCI readmission measure centers on the likelihood that, in its present form, it is not specific enough to exclude the many readmissions that have nothing to do with the quality of the initial PCI. For example, in addition to preventable readmissions, planned procedures, such as gall bladder surgery, colonoscopy, hip replacement surgery, ICD battery changes, and amputations, would be captured by the measure and would inflate the overall readmission rate.

The Society believes that significant refinement is needed before the measure can be appropriately used to judge performance. For starters, rather than a 30-day readmission period, which might be appropriate for a surgical procedure, SCAI is advocating a 7-day period, which has been shown to capture the readmissions most likely linked

directly to PCI. SCAI President Steven R. Bailey, M.D., FSCAI, explained why in a letter submitted to CMS during the public comment period: “The longer the length of time after a patient’s discharge, the more likely it becomes that the readmission is not related to the initial admission but rather to other co-morbidities that our patients have. It also makes it more and more unlikely that that readmission could have been reasonably anticipated or prevented by the hospital or its agents, which is the key goal of a good metric.”

S C A I a l s o u r g e s l i m i t i n g readmission data to diagnoses that could reasonably be attributed to the initial PCI—for example, chest pain, myocardial infarction, unstable angina, repeat revascularization, or vascular complications, all of which are currently captured in the CathPCI Registry. Hospitals could use data on PCI-specific complications to enhance existing systems of care and avoid preventable readmissions. As it stands now, the measure is likely to tabulate readmissions for such procedures as cholecystectomy, endoscopy, and wound debridement—all of which are among the 100 most common readmissions following PCI. Additional codes among the top 100 include electrocardiography, echocardiography, and other diagnostic tests that do not necessarily indicate a problem but, rather, might signal good follow-up for a known complication.

As a result of SCAI’s advocacy, the measure does

Steven R. Bailey, M.D., FSCAI

H. Vernon Anderson, M.D., FSCAI

PCI Readmission Measure (cont’d from pg 1)

hoW SCAI MEMbErS CAn TAKE ACTIon

The proposed PCI readmission measure is cur-rently under review by the National Quality Forum, which will make final recommendations to CMS. A cardiology technical advisory panel will review and revise the measure first, then submit it to the Forum’s main steering committee for patient outcomes. The steering committee’s membership roster is listed on page 5. SCAI members are en-couraged to contact steering committee members to urge the following changes in the PCI readmis-sion measure:• Change the readmission period from 30

days to 7 days after the index PCI, to more accurately capture PCI-specific readmissions and

exclude readmissions linked to more invasive surgical procedures.

• Limit readmission diagnoses to those that can reasonably be attributed to PCI, rather than including all-cause readmissions. Preventable readmission requires targeted measure specifications.

• In addition to excluding staged coronary pro-cedures from readmission data, exclude pre-planned procedures of all kinds. In some cases, PCI may have been performed to prepare a patient to safely undergo major surgery.

• Eliminate “all-cause” readmission data to avoid inappropriate capture of planned procedures.

Advocacy

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5

exclude readmissions for staged cardiac procedures, but SCAI believes that other pre-planned procedures should also be excluded. “Identifying the reason for the second admission is not always easy,” said H. Vernon “Skip” Anderson, M.D., FSCAI, a professor of medicine at the University of Texas Health Sciences Center in Houston, and a member of the technical expert panel that advised YNHHSC/CORE and CMS on the quality measure. “Sometimes an intervention is done in preparation for another procedure, such as a hip replacement. It would be inappropriate to attribute that type of readmission to PCI.”

Developers of the PCI readmission measure say that both the 30-day readmission period and the inclusion of all-cause readmissions are justified. First, from a patient’s perspective, any readmission is likely to be an undesirable outcome and perceived as a signal that he or she did not received care for all of the underlying conditions. Second, a readmission that appears unrelated to PCI might, in fact, be linked to the procedure. For example, readmission for acute renal failure and hemodialysis might reflect contrast-induced nephropathy. Third, the proposed measure does not aim to judge the quality of individual interventional cardiologists, but instead to identify problems in entire systems of care, including medication errors, the transition from hospital to home, and follow-up care with a primary care physician.

Still, interventional cardiologists have reason for concern, considering pay-for-performance initiatives and the inclusion of penalties for excessive readmissions in health reform bills under consideration by Congress. “You can appreciate the potential value of this type of measure, but this is such a preliminary step and is so imprecise, clinicians are justified in their concern,” Dr. Anderson said. “It has to be done for knowledge-gathering and not be at all punitive.”

The measure has recently been submitted to the National Quality Forum for evaluation by the main steering committee for patient outcomes. The steering committee’s first step has been to begin formation of a cardiology technical advisory panel under the direction of Edward F. Gibbons, M.D., to revise and refine the measure. SCAI is submitting nominations for membership to that panel. The entire process is expected to be completed by July 2010.

SCAI members are encouraged to contact members of the NQF steering committee to urge refinement of the PCI readmission measure (see sidebar). n

national Voluntary Consensus Standards for Patient outcomes Main

Steering Committee

Edward F. Gibbons, M.D.UniversityofWashingtonSchoolofMedicine,Seattle,WAChair,CardiologyTechnicalAdvisoryPanelRuben Amarasingham, M.D., MBAParklandHealthandHospitalSystem,Dallas,TXLawrence Becker XeroxCorporation,Rochester,NYE. Patchen Dellinger, M.D. UniversityofWashingtonSchoolofMedicine,Seattle,WAAnne Deutsch, Ph.D., R.N.RehabilitationInstituteofChicago,Chicago,ILJoyce Dubow, MUPAARP,Washington,DCBrian Fillipo, M.D., MMM, FACPConnecticutHospitalAssociation,Wallingford,CTLee Fleisher, M.D. UniversityofPennsylvania,Philadelphia,PALinda Gerbig, R.N., MSPH TexasHealthResources,Arlington,TXSheldon Greenfield, M.D. UniversityofCalifornia,Irvine,Irvine,CALinda Groah, R.N., MSN, CNOR, FAANAssociationofperiOperativeRegisteredNurses,Denver,COPatricia Haugen NationalBreastCancerCoalition,SiouxFalls,SDDavid Herman, M.D.MayoClinic,Rochester,MNDavid S.P. Hopkins, MS, Ph.D.PacificBusinessGrouponHealth,SanFrancisco,CADianne Jewell, PT, DPT, Ph.D., CCSVirginiaCommonwealthUniversity,Richmond,VADavid A. Johnson, M.D., FACP, FACG, FASGE AmericanCollegeofGastroenterology,Norfolk,VAIver Juster, M.D.ActiveHealthManagement,Sausalito,CABurke Kealey, M.D., FHMHealthPartners,Minneapolis,MNPauline McNulty, Ph.D.Johnson&JohnsonPharmaceuticalServices,LLC,Raritan,NJLee Newcomer, M.D., MHA UnitedHealthCare,Minneapolis,MNVanita Pindolia, Pharm.D., BCPSHenryFordHealthSystem,Detroit,MIAmy K. Rosen, Ph.D. BostonUniversitySchoolofPublicHealth,Bedford,MABarbara J. Turner, M.D., MSED, MA, FACPAmericanCollegeofPhysicians,Philadelphia,PABarbara Yawn, M.D., MSc, MPH, FAAFPOlmsteadMedicalCenter,Rochester,MN

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Founders’ Lecture (cont’d from pg 1)

“It will be fun to present to a group of largely younger physicians about how it was in the early days,” Dr. Hartzler said. “There’s a lot they can learn from our experiences.”

A true pioneer, Dr. Hartzler per formed the f i r s t coronary angioplasty at the Mayo Clinic in 1979, a mere two years after its debut in Switzerland by Dr. Andreas

Gruentzig. In 1980 he joined the Mid America Heart Institute in Kansas City, MO, where he built a world-class reputation for furthering progress in angioplasty to encompass the treatment of multivessel disease and complex lesions.

In his Founders’ Lecture, Dr. Hartzler will show how far interventional cardiology has come in 30 years, and just how inventive—and courageous—early interventionalists had to be. In the late 1970s and early 1980s, the equipment was “limited and abysmal,” Dr. Hartzler said. Guide

catheters were stiff, balloon catheters were bulky, and guidewires were fixed and unsteerable. In addition, there were no stents to treat abrupt vessel closure and restenosis.

“One of the things old-timers had to master was how to deal with horrible complications,” Dr. Hartzler said. “These could be moments of sheer terror, but today, young interventional cardiologists may never even see such complications during their entire fellowship.”

Thanks to advances in balloons, wires, stents, and drugs, angioplasty today not only boasts excellent procedural success and long-term outcomes, it is widely available throughout the world.

“With devices that actually work and medications that reduce acute thrombotic occlusion, angioplasty has become a commodity,” Dr. Hartzler said. “Today, all interventional cardiologists have the tools to render world-class care to patients.”

For more information and to register for the SCAI 2010 Scientific Sessions, May 5–8, 2010, in San Diego, CA, visit www.SCAI.org/SCAI2010. n

The development of pediatric interventional cardiology is a medical advance Dr. Moore both witnessed first-hand as Dr. Mullins’ protégé and has taken a leading role in promoting as a clinician and researcher since the mid-1980s. Today he directs cardiology at Rady Children’s Hospital in San Diego and is a professor of pediatrics at UCSD School of Medicine.

In exploring the history of stenting for congenital heart disease, Dr. Moore will focus on the contributions of Dr. Mullins, a self-styled “tinkerer and gadgeter” who collaborated with Dr. Julio Palmaz in stent design. He then pioneered the use of stents for the treatment of congenital heart disease. Eventually, he reported the largest clinical series on stenting for pulmonary branch stenosis and led the way for stenting to become the standard of care.

“Dr. Mullins is the most important figure in the development of stents for the treatment of congenital heart disease,” Dr. Moore said. “He is a real luminary.”

Dr. Moore will also focus on today’s use of stenting for the treatment of congenital heart disease, highlighting a handful of interesting and innovative

current applications. These include new stent designs and the use of stenting for patent ductus arteriosus, for bridging totally occluded blood vessels, and for calibrating atrial septostomy. He plans to discuss the growing awareness of the mass effect of stents, and the need to prevent harm to adjacent structures, such as airways.

As for the future of stenting, Dr. Moore foresees several exciting developments, including biodegradable stents that avoid the problem of undersizing as a child grows, and covered stents that may decrease in-stent restenosis. He will also explore the potential to use catheter-mounted magnets to align adjacent blood vessels when creating shunts with radiofrequency energy.

“I hope to offer up some brain food for the audience,” Dr. Moore said. “We’re always asking: Can we stretch further beyond our current treatments? Is there something more we could possibly do for our patients?”

For more information and to register for the SCAI 2010 Scientific Sessions, May 5–8, 2010, in San Diego, CA, visit www.SCAI.org/SCAI2010. n

Mullins Lecture (cont’d from pg 1)

SCAI 2010

Geoffrey Hartzler, M.D., FSCAI

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7

Although stroke is the leading cause of disability in the United States and the third leading cause of death, stroke treatment has remained

virtually unchanged since the early days, says SCAI Vice President Christopher U. Cates, M.D., FSCAI, director of vascular interventions at Emory Hospitals in Atlanta.

Now that’s starting to change. “We’re trying to apply the same knowledge that we’ve learned in treating heart attack to the area of stroke,” says Dr. Cates. “We’re using interventional techniques to go in, retrieve the clot, and restore blood flow to the brain.” That interventional approach should improve access to care, he says, since all too often

stroke patients do not get to the hospital in time to take advantage of the standard thrombolytic therapy.

To provide the necessary knowledge physicians need and prepare them in stroke-specific interventional techniques, SCAI has designed “The Advanced Curriculum in Acute Stroke Intervention and Carotid Stenting.” The course will be held March 12–13, 2010, in Atlanta, just before the American College of Cardiology Annual Scientific Sessions. Dr. Cates will direct the course, along with Co-director and SCAI Past President Bonnie H. Weiner, M.D., MBA, MSEC, FSCAI, of St. Vincent Hospital in Worcester, MA.

Aimed at interventional cardiologists and others with previous experience in carotid stenting, the course will give participants the chance to build on their knowledge. “It really is a prerequisite that people are pretty adept at getting carotid access as well as access to the neurovascular circulation,” says Dr. Cates. The advanced curriculum will teach participants how to use that access to retrieve clots, fix stenoses, and implant stents to treat intracranial lesions.

The course’s goals are three-fold, says Dr. Cates: to improve participants’ knowledge of stroke and effective new ways of treating it, teach them interventional approaches for acute stroke intervention, and give them a safe way to practice those new skills.

Topics covered will include new and emerging developments in the field, tools and techniques for acute stroke intervention, complicated conditions and situations, and the experiences of practitioners from around the world.

A highlight of the course will be simulator training in mechanical clot retrieval and intracranial stenting. “This virtual reality environment, with real anatomy and real catheters, gives participants hands-on experience,”

Dr. Cates explains. “It’s an excellent way to safely learn this new technique without putting patients at risk and without being in the throes of an acute stroke situation, when everybody’s pulse rate is up.”

Noting that the course has been offered twice previously, Dr. Cates says this year’s offering will feature a new session on neuroimaging techniques, such as computerized tomography and diffusion-weighted magnetic resonance imaging. “This will give participants more experience in interpreting live images in cerebral circulation and blood flow,” he says.

Because of the simulator time, the number of participants will be limited. “The last time we offered this course, it was almost immediately oversubscribed,” says Dr. Cates.

That signals how much the course is needed, he adds. “We’re just trying to fulfill the need to get more and more people trained in this area,” he says. “I think we’ll dramatically improve care for the American people.”

To register or learn more, visit www.SCAI.org/CAS. n

StevenR.Bailey,M.D.,FSCAI,PresidentLarryS.Dean,M.D.,FSCAI,President-Elect

ZiyadM.Hijazi,M.D.,MPH,FSCAI,Immediate Past PresidentChristopherU.Cates,M.D.,FSCAI,Vice President

CarlL.Tommaso,M.D.,FSCAI,TreasurerChristopherJ.White,M.D.,FSCAI,SecretaryMortonKern,M.D.,FSCAI, Editor-in-Chief

_______________________________________________________________

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

2400 N Street, NW, Suite 500, Washington, DC 20037Phone 800-992-7224; Fax 202-689-7224

www.SCAI.org; www.Seconds-Count.org; info@scai.org

TrusteesAlexanderAbizaid,M.D.,FSCAILeeN.Benson,M.D.,FSCAIRobertM.Bersin,M.D.,FSCAITyroneJ.Collins,M.D.,FSCAIDavidA.Cox,M.D.,FSCAIRunlinGao,M.D.,FSCAIJamesA.Goldstein,M.D.,FSCAIRoxanaMehran,M.D.,FSCAIIanT.Meredith,M.D.,FSCAIIssamD.Moussa,M.D.,FSCAITimothyA.Sanborn,M.D.,FSCAIAshokSeth,M.D.,FSCAIKimberlyA.Skelding,M.D.,FSCAICorradoTamburino,M.D.,FSCAIJonathanM.Tobis,M.D.,FSCAIMarkA.Turco,M.D.,FSCAIZoltanG.Turi,M.D.,FSCAI

Trustees for LifeFrankJ.Hildner,M.D.,FSCAIWilliamC.Sheldon,M.D.,FSCAIStaffNormLinskyExecutiveDirectorKerryO’BoyleCurtisSeniorDirectorforEducation,Meetings,andCommunicationsWaynePowellSeniorDirectorforAdvocacyandGuidelinesKathyBoydDavidCommunicationsDirectorMaryHoganMembershipManager

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Just Announced

SCAI to Offer Advanced Curriculum in Acute Stroke Intervention and Carotid Stenting

Christopher U. Cates, M.D., FSCAI

Education

SCAI25037.indd 7 1/14/10 12:27 PM

More than 250 interventional cardiology fellows-in-training assembled at the 2009 SCAI Fall Fellows Courses for five days of in-depth education and networking. They came from six continents, 21 countries, and 36 states, representing the future of interventional therapies and patient care worldwide.

SCAI’s Fall Fellows Courses are eagerly anticipated annual events. This year was the fourth for the adult cardiology program and the second for the pediatric/congenital heart disease program.

Both courses, held Dec. 7–11 in Las Vegas, covered a diverse range of topics and received enthusiastic

feedback from the fellows-in-training. They favored small, hands-on sessions, including opportunities to work on simulators, as well as the annual Jeopardy competition, where leaders in interventional cardiology faced off against each other in a contest to see who has the best handle on the specialty’s trivia. James Hermiller, M.D., FSCAI, co-chair of SCAI’s 33rd Annual Scientific Sessions, won.

The fellows also made time to visit SCAI’s Career Center, which showcases job opportunities from all over the United States, and the Interventional Fellows Institute, where fellows signed up for the complimentary educational modules.

The adult cardiology program was directed by Michael J. Cowley,

M.D., FSCAI, Bonnie Weiner, M.D., MSEC, MBA, FSCAI, and Christopher U. Cates, M.D., FSCAI. Ziyad M. Hijazi, M.D., MPH, FSCAI, directed the adult congenital/pediatric/structural cardiology course. More than 30 renowned interventional cardiologists served as faculty, making time not just for lectures from the podium but also small-group discussions about how to launch and nurture a career in today’s complex healthcare environment.

For more information about SCAI’s Fall Fellows Course, including news about next year’s program and how to register, visit www.SCAI.org. n

Fall Fellows Courses Prepare Tomorrow’s Interventionalists for Successful Careers

8 Early Career

A highlight of the program for many fellows was working on the simulators and with seasoned interventional cardiologists, such as SCAI Past President Dr. George Vetrovec, shown here.

Dr. James Hermiller

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Dr. James Hermiller

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Now that you’re finishing fellowship it’s time to look for a job. This should be the

easy part, right? Unfortunately, for most physicians, it is not. What you do here will be the most important work you’ll do for yourself (and your family) – perhaps ever! While the best training programs in the country produce outstanding cardiologists, they

often provide no information on how to look for a job, what graduating fellows should be thinking about before looking, or how they should go about seeking employment. Unfortunately, many cardiologists don’t learn the tricks of the job-searching trade until they’re in a job – and, by then, for many it may be too late to undo any damage.

It is critical for fellows (or any other cardiologists) seeking employment to focus on several core principles of employment. The first step, as I discussed in the last issue of this newsletter, is to decide what you are looking for in a job. Now, let’s focus on the next step: how to find out what jobs are available.

Talk With Your ContactsMultiple avenues are available for learning about job

openings. The time to start thinking about your career aspirations is when the fellows a year ahead of you are starting to interview. Learn from them how they found out about job opportunities, how they are being received by potential employers (e.g., what skills are employers seeking), and what they have learned in their interviewing. Inquire about the salary and benefits packages being offered and whether there were any surprises.

Faculty contacts are also important. Most faculty, and junior faculty especially, have insight into the process, and will often have contacts in geographic areas (and even specific hospitals) you want to pursue. Mentors who have worked with you for several years will consider it a privilege to help in your efforts – it validates their work with you and fulfills their commitment to you when you were recruited into the fellowship program.

Similarly, if you have worked in any hospitals, as a resident, fellow, or moonlighter, don’t be afraid to contact any physician or administrator who can provide information on the current recruiting status of that hospital or its physician groups.

Think back to your internal medicine residency. Are there any graduates of your residency program in a geographic area where you are seeking employment? If so, they may know of potential opportunities and be able to provide background information on the practice.

Recruiters Can HelpRecruiters may start to contact you and provide

information on available opportunities. There are three types of recruiters, and it is important that you know the motivation of any recruiter who contacts you. Remember, while recruiters will stress that their services will not cost you anything, they are working for the practice seeking to recruit a cardiologist; they are not working for you and thus are aligned not with you but with your potential employer. • Recruiters working on a contingency fee will be paid

only if they produce a candidate who signs with the practice. They generally do the least amount of re-search on you and know the least about the practice you may be joining. Their motivation is to provide as many acceptable CVs as possible to the practice and hope one signs.

• Those working on a retainer are paid a set fee (plus expenses) to find and sign a candidate for the practice. The quality of their work can be variable, though they generally are better informed about the practice and are more discriminating with regard to the candidates they present.

• Outsourced recruiters are contracted by larger practices and hospitals to find physicians in many specialties and usually have someone working on a full-time basis to fill those slots. While contingency, retained, and outsourced

recruiters are appropriate in given circumstances, it’s worthwhile for you to know what their arrangement is with any practice.

Review Journals and Job BanksJournal ads can be a rich source of job opportunities.

Review ads in the New England Journal of Medicine, Journal of the American College of Cardiology, American Journal of Cardiology, and even informal periodicals like Cardiology News. These can provide information on where the jobs are and which recruiters focus on cardiology positions. They may also provide information on starting salary and benefit ranges.

Many potential employers have gone paperless. Rather than rely on print journal ads or direct mailings, they have turned to the Internet. Our professional societies, including SCAI and ACC, have sites devoted to job searches. You can also let potential employers know you are looking for a position by posting your CV and job requirements on these sites.

Reach Out YourselfIf you have a particular geographic area in mind but

have no contacts there, consider direct mailings. Create a

Peter L. Duffy, MD, MMM, FACC, FSCAI

Your First Job: Where to Look, Resources to MineBy Peter L. Duffy, M.D., MMM, FACC, FSCAI

Early Career

SCAI25037.indd 10 1/14/10 12:27 PM

11

form letter that can be personalized in a Word document and sent to all cardiologists in your preferred area. You can obtain lists of cardiologists in the member section of the ACC website.

Another great way to introduce yourself to a hospital or practice is to present yourself directly. If you are looking at a practice with four or more cardiologists, call their administrator and learn more about their needs and whether there may be an opportunity for you. The physicians themselves are generally quite busy and may not have the time or interest to talk with you initially, but the administrator invariably will. This will get your name and CV into the group and give you a contact if it is an opportunity you’d like to pursue.

Practice administrators generally have a clear perspective on the needs of their practices, and their support may be invaluable to you. In addition, even if there is not a position available in their group, they may know of another group that is recruiting.

Consider Short-Term Work OptionsDon’t overlook locum tenens opportunities. These are

short-term jobs that allow you to contract with a potential employer so you both can get to know each other better before signing a long-term contract. This is an excellent way to see if you like the practice and your family likes the area before making a long-term commitment. Under these arrangements the practice generally pays you a set daily fee and all of your expenses, including travel and lodging. Make sure that you understand the call commitment, your job responsibilities, and work hours before you agree to this arrangement.

Most national cardiology meetings now have events dedicated to job opportunities. Be sure to contact both SCAI and ACC about those meetings to see if they fit your needs. There are also many local cardiology

organizations (including state chapters of ACC and regional cardiovascular societies) where important networking can take place. Working within these groups may provide insight into the regional job market and allow you to develop contacts that can help in your search. People really are willing to help – they just need to know that you are looking!

Stay Tuned These tips are meant to help job seekers identify

where the jobs are – but an important fi rst step is to identify what kind of job you are looking for. Watch for future articles in this newsletter for more guidance on your job search, and visit SCAI’s resources for fellows-in-training at www.SCAI.org/FITness.

Dr. Duffy is Founding Partner of Pinehurst Cardiology Consultants in Pinehurst, NC, and is board certified in Interventional Cardiology. He has a master’s degree in Medical Management from Carnegie Mellon University. He can be reached at pld@nc.rr.com. n

A new document that jointly updates two separate sets of clinical guidelines—one on percutaneous coronary intervention (PCI)

and the other on ST-elevation myocardial infarction (STEMI)—has all the elements of a must-read.

“There’s something for everybody,” says James Blankenship, M.D., FSCAI, cardiology director at Geisinger Medical Center in Danville, PA, and a member of the PCI writing group. “A taboo has been lifted (left main stenting), and a longstanding debate

has been aired (aspiration thrombectomy). There’s a new drug (prasugrel) and new recommendations about stents. And for those interested in health services, there are detailed recommendations on STEMI referral systems.”

The new focused update revises 2004 STEMI guidelines and 2005 PCI guidelines, as well as 2007 focused updates to each of those documents. A joint effort of SCAI, the American College of Cardiology (ACC), and the American Heart Association (AHA), the fast-track project took just nine months to complete from fi rst conference call to publication.

“New and important studies are released every

New Update to STEMI/PCI GuidelinesRefl ect Latest Clinical Data

(continued on page 12)James Blankenship, M.D., FSCAI

CH ECK OUT SCAI’S ON LI N E CAR EER B AN K FOR LI STI NGS OF I NTER VENTI ONAL CAR DI OLOGY P OS ITI ONS TODAY!

LOG ON TO: http://www.scai.org/DRLT1.ASPX?PAGE_ID=3894

ready for a Job?

SCAI25037.indd 11 1/14/10 12:27 PM

few months,” Dr. Blankenship said. “To be relevant and to retain credibility with practicing cardiologists, guidelines have to reflect the current evidence base.”

Among the most notable changes in the guidelines is reclassification of stenting of the left main coronary artery. A previous Class III indication meant the procedure was contraindicated in most cases. Now left main stenting has been given a Class IIb rating, indicating that interventional cardiologists may consider this option when procedural complications are likely to be low and the risk from bypass surgery is elevated.

“There is mounting evidence that stenting of the left main coronary artery, under certain circumstances, does carry a reasonable outcome,” said Spencer B. King III, M.D., MACC, FSCAI, president of the Saint Joseph’s Heart and Vascular Institute and a professor of medicine emeritus at Emory University School of Medicine in Atlanta. “Now stenting

might be considered, based on the specific anatomy of the coronary arteries and the risk profile of the patient.”

Other key changes in the focused guidelines update include the following:• It is reasonable to perform aspiration thrombectomy

as part of primary PCI in patients with STEMI. • Each community should develop a system for the

triage and care of patients with STEMI, modeled after the AHA’s Mission Lifeline initiative. Such a system would include prehospital diagnosis of STEMI, initial ambulance transport to PCI-capable hospitals whenever possible, and transfer

protocols for rapid transfer between non-PCI hospitals and PCI centers.

• High-risk STEMI patients should be transferred to a PCI hospital as soon as possible after treatment with a fibrinolytic agent at a non-PCI hospital, rather than waiting to see whether reperfusion therapy is successful.

• The new anti-platelet agent prasugrel may be given as an alternative to clopidogrel, specifically 60 mg at the time of primary PCI, followed by a maintenance dose of 10 mg daily for at least 12 months in patients who receive a stent. Prasugrel should be withdrawn at least 7 days before bypass or other surgery.

• The use of a drug-eluting stent as an alternative to a bare metal stent is reasonable in primary PCI.

• It is reasonable to assess the hemodynamic significance of intermediate coronary lesions by using fractional flow reserve to measure coronary pressure or by using Doppler measurements.

• For patients with chronic kidney disease who are not on chronic dialysis, either an isosmolar or a low molecular weight contrast agent may be used.“These guidelines are a distillation of all the

relevant evidence,” said Dr. King. “They will help physicians to make the best choices for their patients.”

The new focused update was published online in Catheterization and Cardiovascular Interventions on Nov. 18, and in the Dec 1 print issues of both the Journal of the American College of Cardiology and Circulation. It is also available on the SCAI web site (www.SCAI.org), as well as the web sites of the ACC and the AHA. n

12

Spencer B. King III, M.D., MACC, FSCAI

A few lost battles but victory in the war itself: That’s how one interventional cardiologist describes the final outcome of a fight to preserve coverage

of drug-eluting stents (DES) for Medicaid beneficiaries and state-insured employees in Washington State.

Charged with ensuring that the medical care the state pays for is safe and effective, Washington’s Health Technology Assessment (HTA) Committee proposed last summer to restrict its coverage of DES to only the direst cases. Under pressure from SCAI and others, the committee then reversed its decision and appointed an ad hoc committee to re-evaluate the evidence (see “Advocacy Update 8/31/09” on www.SCAI.org). In October, the HTA committee made its final decision.

Both sides can claim victory, says Michael E. Ring, M.D., FSCAI, chair of the ad hoc committee and medical director of Providence Heart and Vascular Institute of Spokane. “The HTA Committee can say that they’ve imposed some restrictions on drug-eluting stents,” he says. “But in terms of the final decision’s effect on interventional cardiologists and their patients, the impact is going to be, fortunately, very minimal.”

The state agreed to cover DES in any of the following situations: stent diameter of 3 millimeters or less,

Washington State Panel Votes to Preserve Coverage of Drug-Eluting Stents

Michael E. Ring, M.D., FSCAI

STEMI/PCI Guidelines (cont’d from pg 11)

Advocacy

SCAI25037.indd 12 1/14/10 12:27 PM

cumulative length of stents greater than 15 millimeters, diabetes, previous in-stent restenosis, and treatment of left main coronary disease. In the committee’s original proposal, the first two conditions focused on vessel and legion size rather than stent diameter and length. The latter two conditions, as well as the consideration of the cumulative length of stents, were additions made with guidance from members of the ad hoc committee recommended by SCAI.

There are still some situations, such as bifurcation lesions and chronic total occlusions, where the state won’t cover DES, but those exclusions won’t make a big difference, notes Steven L. Goldberg, M.D., FSCAI, a member of the ad hoc committee and director of the cardiac catheterization lab at the University of Washington in Seattle. “In those situations, it’s likely that

you’d end up using more than 15 millimeters of stent,” he explains. “They made a statement, but practically speaking it’s not going to amount to much.”

Having interventional cardiologists involved in making decisions that affect their patients is how it should be, emphasizes Dr. Ring, noting that no interventional cardiologists serve on the HTA

Committee. It was significant that they agreed, with SCAI and others, to include interventional cardiologists on the ad hoc committee.

“I understand the state’s perspective: Their budget has taken a huge hit, and if they can save money they’ll be able to put more people on the rolls and provide more care,” he says. “The problem is that the people making those decisions aren’t, for the most part, familiar with cardiac patients.”

In addition to Drs. Ring and Goldberg, other SCAI members were involved in the fight. SCAI President-Elect Larry S. Dean, M.D., FSCAI, took the lead in preparing comments in response to the HTA Committee’s original proposal; SCAI Trustee Robert Bersin, M.D., FSCAI, made a presentation at the committee’s meeting last May; and other members contributed to SCAI’s oral and written presentations to the committee.

Although the committee’s decision is final for now, the state requires periodic re-evaluations. Both Dr. Ring and Dr. Goldberg worry that what has happened in Washington could set a precedent for other states or even the federal government.

“Our fellow cardiologists in other states should be vigilant,” emphasizes Dr. Ring. “We need to be prepared to advocate for our patients.” n

13

Steven L. Goldberg, M.D., FSCAI

gETTIng InVolVED In ADVoCACY If Steven L. Goldberg, M.D., FSCAI, of the University of Washington hadn’t slipped a disc in his back, he would probably never have gotten involved in advocacy efforts with SCAI.

“My orthopedic surgeon sent me an email saying, ‘We were just involved in defending spine surgery against the Health Technol-ogy Assessment (HTA) Committee, and I see they’re coming after stents now,” says Dr. Goldberg. “He said this was something I needed to be aware of and take action against.”

Take action Dr. Goldberg did, along with other interventional cardiologists in Washington State. He helped a consulting firm review the literature on DES, voiced his concerns, answered the HTA Committee’s questions, and served on an ad hoc committee to re-evaluate the evidence. The advocacy efforts of Dr. Goldberg and many other interventional cardiologists worked in the end (see article).

The experience was eye-opening, says Dr. Goldberg, and not just because people who weren’t interventional cardiolo-gists were making decisions that would affect his patients. He believes that the HTA Committee’s real agenda was to shift costs from the state to the hospitals. “Physicians are not going to make decisions based on insurance but based on what they think is right for their patients, so the hospital would end up eat-ing those costs,” he says.

Dr. Goldberg was also shocked by how contentious the fight was, even within the ad hoc committee. “We really couldn’t come to common ground,” he says, noting that some members strayed from the committee’s mandate to take “potshots” at interven-tional cardiology. “It was as bad as the Senate!”

To the ad hoc committee’s chair, Michael E. Ring, M.D., FSCAI, of Providence Heart and Vascular Institute of Spokane, the suspicions about interventional cardiology are ironic. “If we were really advocating for our own bottom line, we would want to eliminate drug-eluting stents, because they reduce the number of procedures we get to do in the long run,” he says.

Helping to fight the HTA Committee was time-consuming, adds Dr. Goldberg, citing seven hours of conference calls, another four for an in-person meeting, and hours more reviewing evi-dence. But it was worth the effort, he says. Dr. Ring agrees. And he urges other interventional cardiologists to get involved. “There’s going to be a lot on the advocacy front that’s going to need our input,” he says. “The important thing is that cardiologists be at the table, not on the menu.”

For information on how you can help with SCAI’s advocacy efforts, visit the SCAI Advocacy Action Center at www.SCAI.org.

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In the Trenches

When David Jessup, M.D., FACC, FSCAI , took

his fi rst job as a peripheral interventionalist at North Cascade Cardiology, PLLC, in Bellingham, WA, he didn’t wait for patients to come to him. He spent the fi rst opening in his schedule across the street, meeting a family practice group and offering his help.

He already knew the doctors in his own group. D r. J e s s u p a n d f o u r colleagues all came from the same training program at the University of Utah. “I interviewed at a lot of good places, but we had already built trust with one another after long hours of training together,” says Dr. Jessup.

For the past fi ve years he has worked with his partners to provide comprehensive cardiovascular care to their patients. “We take the university model to private

practice: we each focus our expertise into one area so we can provide the highest quality care in that area,” says Dr. Jessup. “That’s what makes this group really special.”

Specializing in the Whole PatientNow Dr. Jessup is the medical director of the

vascular medicine clinic he was asked to build when he joined North Cascade Cardiology. “It’s grown dramatically over the past fi ve years,” says Dr. Jessup. “It encompasses almost a third of our patient clinic visits.”

He stresses the importance of calling it a “vascular” rather than an “endovascular” clinic.

“It’s a medicine clinic, not a stent clinic. I am a doctor fi rst and an interventionalist second. If I do an intervention—and I really love to do them—it’s almost a failure of my ability as a medical interventionalist to keep patients out of my cath lab.

“As interventionalists we have a tendency to refer to patients as ‘LADs’ or ‘renals’ and that gives the impression that all we’re into are procedures,” says Dr. Jessup. “But patients are people to me—I really enjoy talking to them.”

Bellingham is a small town surrounded by other small towns, so it’s not unusual for Dr. Jessup to see his

patients outside of the clinic. “I’ve run into patients at the city pool,” he jokes. “I’m in my bathing suit and they’re in theirs!”

Patients in the CenterDr. Jessup views medicine as a wheel with patients

at the center. “The hub is the patient and the spokes are the

service lines from all their physicians and other health professionals who care for them,” he explains. “To keep that wheel turning, I work very hard to communicate effectively with everyone else on the wheel.”

It can be diffi cult to keep so many people in the loop, but Dr. Jessup views it as his job to fi gure out a way. One example: He’s turned his trusty iPhone into a tool for doctor-to-doctor communication. After completing an angiogram, it takes just moments to email a few images to the patient’s primary care physician. “Our patients have chosen to trust us, so it’s our professional responsibility to communicate effectively with each other – and our colleagues in primary care appreciate it, too.”

A Newsletter for Referring PhysiciansOne day, three years ago during an unusually bad

snow storm in Bellingham, Dr. Jessup envisioned another way to connect with his referring physicians. “A lot of folks weren’t showing up for their appointments and I thought, ‘What do I do? I’ve got to do something with this free time.’”

In the next few hours, a newsletter, now written quarterly and eagerly anticipated by providers in the area, was born.

His goal on that snowy day when the patients stayed home was to develop a tool that might change what has always been a challenge for peripheral cardiologists—a deeply engrained referral pattern.

“If you have a carotid, you see a surgeon. If you have chest pain, you see a cardiologist,” he explains. “I wanted to change that paradigm so I’m seen not as a cardiologist, but as a cardiovascular medicine specialist.”

With just a little help from a friend who looks for typos, Dr. Jessup now distributes his email to about 75 local physicians. He’s careful to focus on topics relevant to primary care and to include as much up-to-date, factual information as he can.

“The newsletter typically feeds itself,” says Dr. Jessup. “The questions I receive from one newsletter often become the topic for the next.”

For such a simple thing, the newsletter has achieved big results for Dr. Jessup’s practice, yielding an increase in patient volume and in second opinions on patients already seen by local and regional surgeons.

“It has elevated our position in the community,” he

Dr. David Jessup: Doctor First, Interventionalist Second

“I want to be seen not as a cardiologist, but as a cardiovascular medicine specialist. That

means working very hard to communicate with all the providers who take care of my

patients, too,” says Dr. Jessup.

14

SCAI25037.indd 14 1/14/10 12:28 PM

explains, “and the fact that we’re trusted to care for referring physicians’ patients means a lot.”

New to SCAI“I hadn’t been active in SCAI until this year’s TCT,

when Dr. Steve Bailey and I fi rst met,” says Dr. Jessup. In the past, he’d been hesitant to get involved with SCAI because “there are big names at SCAI, and I’m just brand new!”

But after sharing copies of his newsletter with SCAI leaders and staff, they encouraged him to get more involved and he has.

He thinks it’s important to reach the “young crowd,” identifying the issues they face and doing what he can to help. When asked what advice he would give to newer interventionalists, he reiterated the importance of putting the patient fi rst and communicating with other physicians.

What else? “Do what you think is right and in the patient’s best interest, regardless of potential fallout, political ramifi cations, or cost. You may not actually be right, but if people think you’re doing it for the right reason, for the most part they’ll pick you up, dust you off, and keep you going.” n

FROM SCAI AND PARTNERS

SECOND ANNUAL PAN VASCULAR SUMMIT

Date: Feb. 19–20, 2010Sponsor: University of Utah School of MedicineLocation: Midway, UTDirectors: Andrew D. Michaels, M.D.For more info: www.panvascularsummit.org

CRT 2010

Date: Feb. 21–23, 2010Sponsor: Washington Hospital CenterLocation: Washington D.C.Directors: Ron Waksman, M.D.For more info: www.CRTOnline.org

SCAI ASIA PACIFIC FELLOWS COURSE

Date: Feb. 24–26, 2010Sponsor: Escorts Heart Institute and Research CenterLocation: New Delhi, IndiaDirectors: Ashok Seth, M.D., FSCAI, FRCP, FACC, FIMSA, Bonnie Weiner, M.D., MSEC, MBA, FSCAI, Christopher U. Cates, M.D., FSCAI, and Michael Cowley, M.D., FSCAIFor more info: http://www.indialive2010.com/scai.htm

CME

SCAI-COSPONSORED PROGRAMS

ADVANCED CURRICULUM IN ACUTE STROKE INTERVENTION AND CAROTID STENTINGDate: March 12–13, 2010Location: Atlanta, GADirectors: Christopher U. Cates, M.D., FSCAI, and Bonnie Weiner, M.D., MBA, MSEC, FSCAIFor more info: www.SCAI.org

SCAI 33RD ANNUAL SCIENTIFIC SESSIONSDate: May 5–8, 2010Location: San Diego, CADirectors: James B. Hermiller, M.D., FSCAI, Christopher J. White, M.D., FSCAI, Frank F. Ing, M.D., FSCAI, and Daniel S. Levi, M.D., FSCAIFor more info: www.SCAI.org/SCAI2010

GLOBAL INTERVENTIONAL SUMMIT, IN COLLABORATION WITH THE TURKISH SOCIETY OF CARDIOLOGY Date: Oct. 22–24, 2010Location: Istanbul, TurkeyDirectors: Ziyad M. Hijazi, M.D., MPH, FSCAI, Ted Feldman, M.D., FSCAI, Oktay Ergene, M.D., FSCAI, FESC, and L. Saltik, M.D., FSCAIFor more info: www.scai.org/GIS

SCAI-SPONSORED PROGRAMSFor more information or to register for any of these programs, contact Laura

Brown at lbrown@scai.org or 800-992-7224, or visit www.SCAI.org

JOINTLY SPONSORED WITH SCAIPEDIATRIC AND ADULT INTERVENTIONAL CARDIAC SYMPOSIUM

Date: July 18–21, 2010Sponsor: The PICS Foundation in Collaboration and Rush Center For Congenital & Structural Heart DiseaseLocation: Chicago, ILDirectors: Ziyad M. Hijazi, M.D., MPH, FSCAI, FACC, William E. Hellenbrand, M.D., FSCAI, John P. Cheatham, M.D., and Carlos Pedra, M.D.For more info: www.picsymposium.com

CONCEPTS IN CONTEMPORARY CARDIOVASCULAR MEDICINE SYMPOSIUM (CCCM) 2010

Date: April 8-10, 2010Sponsor: SCAI and Complete Conference ManagementLocation: Houston, TXDirectors: Steven R. Bailey, M.D., FSCAI, Zvonimir Krajcer, M.D., and Richard W. Smalling, M.D., FSCAIFor more info: http://www.cardiovascularconcepts.org/

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