print for the future ofthe specialty andSociety leaders analyzedthe implications of thelatest treatmentadvances. Just hoursbefore he was officiallyelected SCAI president,John McBarronHodgson, M.D.,FSCAI, hosted the Society’s first news conference for jour-nalists. He and Drs. Weiner and Spencer B. King, III, out-lined the challenges associated with rollout of the firstdrug-eluting stents in the United States (see below forrelated story).

Meanwhile, two invited lectures pointed attendees’eyes toward future headlines. Kenneth Kent, M.D.,

Last year, when the Annual Scientific Sessions inSeattle surpassed all expectations, a new standardhad been set, and it was going to be difficult tobeat. The SCAI ’02 Program Committee, chairedby Mark Reisman, M.D., FSCAI, brought every-thing together perfectly: superb education, world-class faculty, a sold-out Exposition, generous unrestricted educational support from industrypartners, exciting social events, and nearly 1,000attendees—double the previous record! However,in raising the bar for SCAI annual meetings, Dr.Reisman and colleagues had also issued an implicitchallenge to their successors, a challenge that thisyear’s Program Committee simply couldn’t resist.

And they delivered, too. Led by BonnieWeiner, M.D., FSCAI, and Donald S. Baim, M.D.,FSCAI, the 2003 Program Committee hosted anannual meeting that lived up to the SCAI motto:Best of the Best in Interventional Cardiology. Theperfect size to attract world-renowned faculty andto encourage intimate, collegial interaction, theBoston Annual Scientific Sessions were teemingwith activity, but not so busy that attendees couldn’tget reacquainted in comfort.

That is the unique hallmark of the SCAIannual meeting: enabling everyone—pioneers,today’s practitioners, and tomorrow’s leaders—togather in a cordial, productive atmosphere. Trusteefor Life (and CCI Journal founder) Frank Hildner,M.D., FSCAI, put it best: “When I was a youngsquirt, I came to these meetings and got to hobnobwith the likes of Sones, Judkins, Gensini, and oth-ers, and that was a terrific experience for me. Nowthat I have a few years under my belt, it’s absolutelyessential that guys like me come to these meetingsfor as long as we can, so that the young folks haveevery opportunity to meet with us, learn from us(though often it’s the opposite), and figure outwhere the heck they’re going. You simply can’t dothat at a big meeting.”

Examining just where the specialty is headedwas one of the unstated themes of SCAI ’03, asinternationally renowned cardiologists drew a blue-

The Society for Cardiovascular Angiography and Interventions Summer 2003

SCAI News & Highlights

www.scai.org

26th Annual Meeting Lives Up to “Best of the Best” Motto

continued on page 3

SCAI Takes Lead on Drug-Eluting StentsWith rollout of the first drug-eluting stent (DES)approved for use in the United States now wellunderway, the Society remains the only professionalmedical group that has issued recommendations forthe adoption of these new devices in practice.During a news briefing in Boston, SCAI leadersJohn McB. Hodgson, M.D., FSCAI, Spencer B.King, III, M.D., FSCAI, and Bonnie Weiner, M.D.,FSCAI, stressed that evidence—not economics—must govern the use of these new devices.

“We’re encouraging our members and otherphysicians to approach the use of drug-elutingstents by considering the evidence, rather thanbeing worried about medicolegal issues or beingconcerned about the economic impact of their use,”said Dr. Hodgson. His comments followed on the

continued on page 4

SCAI

Updates

Its Name

2

Well, they’re finally here. OnApril 24th, the U.S. Food andDrug Administration approved thefirst drug-eluting stent (DES) formarketing. Clearly, the scientificdata regarding the efficacy ofDES are impressive: DES are asignificant advance in the treat-ment of restenosis. For the purpose of comparisons, I havelooked back through the years at

single-vessel, angiographically controlled trials ofeach new device at a time near when they wereintroduced. Early balloon angioplasty resulted inrestenosis rates of 31–37 percent. Later, introductionof “new devices” (directional atherectomy, for exam-ple) saw the restenosis rate fall slightly to 31 percent,but they expanded the lesions we could approach.Subsequently, widespread introduction of stenting(even first-generation, low-pressure devices) loweredit further (22–31 percent). Introduction of high-pressure stenting and application of nonangiographicguiding technologies was another step forward, withrestenosis rates between 10 and 24 percent. Now,DES enters with restenosis rates of 9 percent. I havegraphed the reduction in restenosis with its device-associated cost (corrected for inflation in 2002 U.S.dollars) in an admittedly nonrigorous way, but Ibelieve a fairly accurate one (see Figure 1).

As you can see, for a progressive improvement inrestenosis, DES come at a price increase that appearsto be in line with prior advances. Although formalcost-effectiveness evaluations of the SIRIUS trial

data suggest that “society” is willing to pay the addi-tional cost to achieve lower TLR rates, it is widelyexpected that significant hospital losses will occur.

I recently polled several U.S. colleagues regard-ing how they expected to deal with the use of DESin their institutions and was distressed by the varietyof plans, ranging from universal use (for some due toa belief that DES would be best in all lesions; forsome out of fear of litigation), to a very rigid scoringsystem based on anticipated restenosis risk. Someplanned to use one DES per case with bare-metalstents for the additional vessel/lesions (this seemedto be the most fiscally sound plan, capturing theadded reimbursement while limiting the outlay). Iwas distressed because the planned use had little todo with scientific data, but rather, in many cases, wasdriven by financial considerations or fear of litiga-tion. These responses only confirmed the SCAI polltaken last October and reported in the springnewsletter. In response, we suggested formation of atask force to address the nonscientific issues surround-ing DES implementation. At the recent Bostonmeeting, we convened the first task force, composedof leading economists, industry leaders, policy analysts,payers, and physicians. We had a very productivemeeting and agreed to work on three areas with theintent of providing some guidance to interventionalistsduring these DES “growing pains.”

The first is to explore the economic impact ofDES from four perspectives: the patient, the hospital,the payers, and the health care system. With SCAIleadership, an analysis of this complex problem willbe developed in the near future. The second area offocus for the task force is to look at the impact ofDES on healthcare delivery. In addition, there maybe dramatic programmatic changes, especially inopen-heart surgery programs. The final area is themedical-legal implications surrounding DES use. Thetask force will explore the reality of litigation con-cerns and offer guidance in this area. In summary,the charge of the DES Task Force is to provide up-to-date guidance on the nonscientific aspects ofDES implementation. It is our hope that this guid-ance will be useful in empowering interventionaliststo practice optimal medicine without fear of eco-nomic, legal, or programmatic consequences.

We are in exciting times: Restenosis is now inthe single digits. The treatment of coronary diseasein some ways has never been easier but, in other

President’s Message: DES Task Force Meets in Boston

Figure 1. Estimates of restenosis rates and costs (2002 US$) for variousdevices in single-vessel disease near the time of their introduction. (DCA:directional coronary atherectomy, DES: drug-eluting stent)

continued on page 5

John McBarronHodgson, M.D.,FSCAI, President

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FSCAI, charted acourse for the futureof interventional car-diology, starting witha fascinating look athow quickly it hasevolved since Dr.Andreas Gruentziginflated a small bal-loon in the plaque-laden coronary arteryof a Swiss business-man. “We’re on thethreshold of con-

quering it all—of being able to open almost anyobstruction in an artery and being able to keep it openover the long term,” announced Dr. Kent. The nextday, Valentin Fuster, M.D., Ph.D., described how ultra-fast CT and MRI are enabling cardiologists to charac-terize the biology of plaque and to institute targetedtherapies in high-risk but asymptomatic patients.

The community of congenital heart disease spe-cialists has found a home at the SCAI and is growingby leaps and bounds, said Ziyad Hijazi, M.D., FSCAI,who chaired the meeting’s intensive, three-day programalong with Robert Geggel, M.D., FSCAI, devoted tothese topics. “We’ve created a true learning communityfor congenital heart disease, and it was most evidentwhen the committee met on Wednesday,” added Dr.Hijazi. “The room was packed—more than half of theSociety’s pediatric cardiologist members attended thismeeting—and the ideas were flowing, so much so thatwe plan to meet again during PICS.” The committeereconvened on Friday for an impromptu meeting withfellow pediatric cardiologist and Deputy AssistantSecretary of Health and Human Services Dr. HowardA. Zucker, who later gave a special presentation for allattendees (see page 4). “Dr. Zucker spent 30 minuteswith us, the congenital heart disease specialists,” saidDr. Hijazi. “It was an extraordinary opportunity to

Annual Meeting “Best of the Best”. . . continued from page 1

highlight the issues we are facing and their implicationsfor our patients, such as diminishing reimbursement forinterventional procedures. Dr. Zucker promised to helpus should we need assistance at the government level.”

From start to finish, SCAI ’03 drew rave reviewsfrom attendees and exhibitors alike. SCAI Fellowsapplauded the meeting’s focus on the practical overthe theoretical. The Program Committee’s newapproach to case-review sessions, for example,received overwhelming positive feedback. Stripped of

bells and whistles, these sessions highlighted thepatient profiles attendees are most likely to see intheir practices and helped them to zero in on the“best of the best” treatment strategies.

In keeping with SCAI tradition, a number ofsocial events provided a relaxed atmosphere for oldfriends and their families to catch up and for newconnections to be made. In fact, many deemed thisyear’s banquet the most spectacular in the Society’shistory. The fun began when more than 400 atten-dees boarded buses and caravanned through Bostonto the beautiful John F. Kennedy Library. The sun set-ting over the Atlantic Ocean was a stunning back-drop as a record number of new members were wel-comed to the ranks of SCAI Fellowship.

Kudos to everyone who helped to make theBoston meeting such a rousing success. The count-down to San Diego has begun… ■

SCAI ’02 Program Committee Chair Dr.Mark Reisman with future cardiologist. Dr. Ted Feldman, then SCAI

president, presented Dr.Stephen Balter (Lenox HillHospital, New York City)with the annual SCAIDistinguished Service Awardfor his many years of serviceto the Society.

A Seat at the Table: SCAI, Industry Partners Brainstorm Together on Tough Topics

What better way to say thank-you than to invite someoneto your table? In a display of gratitude for the supportoffered by its top industry partners—GuidantCorporation, Aventis Pharmaceuticals, BostonScientific Corporation, and Cordis Cardiology—atSCAI ’03, the Society hosted a special round-table dis-

cussion for each company. The companies chose thetopics, and the Society invited a number of its Fellowsto participate in the lively conversations that ensued.

Nearly every participant—from the companyrepresentatives to the physicians—reported that theexperience was educational and intriguing. ■

heels of a news release the Societyissued to reporters on April 24th,just hours after the FDA gave itsblessing to the Cordis Cypher™stent. Dr. Hodgson pointed outthat the stents are not appropriatefor all patients and that there willbe thorny ethical, legal, and finan-cial issues that accompany theirwidespread use.

4

Dr. Howard A. Zucker is the U.S. Deputy AssistantSecretary of Health and Human Services. In additionto his title, his list of accomplishments is impressive,making him a sought-after speaker for medical meet-ings far and wide. However, the welcome he receivedat the Society’s Annual Scientific Sessions last monthwas especially warm. The attendees found in Dr.Zucker a colleague who keeps his stethoscope at arm’sreach and takes it with him to the National Institutesof Health every Wednesday when he sees patients.

At SCAI ’03, Dr. Zucker—a pediatric cardiolo-gist himself—joined in an impromptu gathering ofSCAI congenital heart disease specialists for a free-wheeling discussion of issues related to the care oftheir patients: declining reimbursement, the lack ofpediatric-size devices, and access to care. The meetingwas going so well that Dr. Zucker had to be pulledaway for his scheduled speech in the main lecturehall. There, he focused on three headline-makers: thesmallpox vaccine, SARS, and drug-eluting stents.

Dr. Zucker tailored his comments on each ofthese high-visibility topics to the concerns of prac-ticing cardiologists. He discussed the cardiac impli-

cations of the smallpox vaccine, noting that thewidely publicized ischemic events that have beenassociated with the vaccine were probably notcaused by it. In each case, the patient had a historyof cardiovascular disease. Nevertheless, he notedthat the Centers for Disease Control and Preventionis developing new screening criteria for the vaccine,including the exclusion of patients with known cardiovascular disease.

Meanwhile, SARS has provided an excellenttest for the Bush administration’s philosophy of pre-paredness. That philosophy, said Dr. Zucker, allowedthe U.S. healthcare community to rapidly develop aframework for isolation and quarantine. Dr. Zuckernoted that, as of May 7 (the day before his talk atSCAI ’03, his last opportunity to check the statis-tics), there had been only 65 probable cases of SARSin the United States and no deaths—numbers thatstand in stark contrast to those in Asia, for example.

Dr. Zucker also described the administration’sapproach to handling what it calls “disruptive” (asopposed to “breakthrough”) technologies. Drug-eluting stents fall into this category, he said,because they will, in many cases, replace existingtreatments, rather than being incorporated intopractice alongside previously accepted protocols. Inthe case of drug-eluting stents, the Centers forMedicare and Medicaid Services developed a diag-nosis-related group based on an estimated averageof 1.6 stents per patient, and the Food and DrugAdministration fast-tracked premarket approval,reducing the typical timeframe from about 16months to only one year. ■

SCAI Takes Lead. . . continued from page 1

The Society is continuing to take the lead intackling those issues, first with its position paper and,more recently, by convening a multidisciplinary taskforce of representatives from the healthcare economiccommunity, industry, hospitals, government payers andregulators, as well as several professional medical soci-eties. Dr. Hodgson chaired the first meeting of this taskforce in Boston. On page 2, he discusses the goals andpriorities of the task force. ■

SCAI Welcomes Fellow Cardiologist from HHS

The Society was honored towelcome Deputy AssistantSecretary of Health and HumanServices Dr. Howard A. Zuckerto its stage. A pediatric cardiologist and anesthesiologist,Dr. Zucker still uses his stetho-scope every week when he seespatients at the NIH.

Bonnie Weiner, M.D.,FSCAI

5

As a clinical interventional car-diologist in private practice, Icannot recall the release of a newdevice that came with as muchpublic awareness, expectation,and angst as drug-eluting stents(DES). On the one hand, wefinally have an effective primarytreatment for both original coro-nary stenosis and prevention of

the predictable restenosis that occurs in 15–20 per-cent of patients when a bare-metal stent is used. Onthe other hand, because of the cost of DES, if morethan one of the devices is needed per patient, thenwe run the risk of converting our catheterization labo-ratories from profit centers into loss leaders. Thepotential conflict between applying an effective ther-apy to all of my patients and unwittingly restrictingless expensive but still effective therapy to many oth-ers due to financial pressures leaves all of us in theunenviable position of trying to decide which of ourpatients should and which should not get this new

technology. Couple this conflict with the fact thatthere are not enough DES for all patients and wehave a difficult clinical situation for most of us whopractice interventional cardiology.

That’s why I was ecstatic when the SCAI pub-lished “SCAI Statement on Drug-Eluting Stents:Practice and Health Care Delivery Implications” inthe March issue of the Society’s journal,Catheterization and Cardiovascular Interventions(Hodgson et al. Cathet Cardiovasc Intervent 2003;58:397–399). This timely document summarizesthe state of our current knowledge regarding theappropriate use of DES based on the available med-ical evidence. It is serving as the foundation for ourinterventional cardiology community as we devel-op a rational local guideline for the use of DES.This is why I consider my membership in theSCAI to be invaluable. If not for the SCAI, we onthe frontlines of delivery of interventional cardiaccare would be left to wait for months, or evenyears, before any of the other cardiology societiesprovided guidance on this very difficult issue.

In His Own Words…SCAI Fellow Speaks Out on DES

Randy Bottner, M.D.,FSCAI

President’s Message...continued from page 2

ways, never so complex. We should embrace the sci-ence of DES while being careful not to lose sight ofthe other exciting advances of the past 15 years.And, certainly, we cannot rest in our pursuit of evengreater accomplishments, while always keeping the

optimal care of our patients paramount. I will keepyou informed of the task force’s findings and recom-mendations as they become available. I trust theywill offer some guidance for us all. ■

From Cardiac to Cardiovascular...SCAI Updates Its Name

With the addition of just a few sylla-bles, the Society has made animportant change to its name thatreflects the wide expertise of itsmembers and the extensive caretheir patients require. In May, theBoard of Trustees officially changedthe SCAI’s name to the Society forCardiovascular Angiography and Interventions.

No, the initials haven’t changed. And many inthe medical community will continue to think ofthe Society as “Sky,” an easy nickname for the

mouthful that “SCAI” represents. But the wordsbehind the acronym tell members, future members,and patients about the Society’s focus. “Changingthe word Cardiac to Cardiovascular was more than asymbolic change,” said Christopher J. White, M.D.,FSCAI, who is editor-in-chief of Catheterization andCardiovascular Interventions. “The days when thepractice of cardiology was confined to the heart arelong past. The long-term, system-wide approach weuse to treat our patients, including prevention andrevascularization, should be indicated by the nameof our Society.” ■

6

Physicians-in-training who have demonstrated med-ical excellence and whose research promisesadvances in cardiovascular imaging and invasivetechniques are invited to apply for the 2004–05Annual Bracco Diagnostics, Inc.-ACIST MedicalSystems/SCAI Fellowship Program for Research inCardiac Imaging and Invasive Cardiology. Bracco-ACIST and the Society share a commitment toencouraging meaningful scientific investigation inthese areas and to fostering new insights intopatient care.

Two applicants will be awarded one-year fellowships at the Society’s 27th Annual ScientificSessions in San Diego. The award amounts willvary, up to a maximum of $25,000, based on thesubmitted research proposals.

Awards will be made directly to the recipient’snonprofit sponsoring institution and should beapplied to direct research costs only, not to includethe fellow’s salary. Grants are limited to research donein the United States or Canada. In addition, travelexpenses will be paid for the awardees to attendSCAI ’05, where they will present their findings.

2002–03 Awardees Present Research in Boston

The presentations of the awardees are always a high-light of the SCAI Annual Scientific Sessions. InBoston, the Society was pleased to welcome D. Scott Lim, M.D., and Yerem Yeghiazarians, M.D.,who received last year’s fellowship awards. Dr. Limpresented the results of his research on “ThermalIndicator Dilution—A Novel Method forQuantification of Small Left-to-Right Shunts inPalliated Single-Ventricle Anatomy.” Dr.Yeghiazarians also presented the findings from hisresearch, on “Identification and Characterization ofthe Vulnerable Atherosclerotic Plaque byIntravascular Magnetic Resonance Imaging.”

2003–04 Awardees Announced

The Society and Bracco-ACIST extend congratula-tions to the recipients of the 2003–04 awards:

• Amish N. Raval, M.D., of GeorgetownUniversity Medical Center in Washington, D.C.,whose research proposal is titled “UnderstandingCoronary Atherosclerosis in Patients withDiabetes: A Prospective IVUS Evaluation”

• Scott H. Yang, M.D., of the University of TexasHealth Science Center at San Antonio, whoseresearch proposal is titled “Assessment of CardiacMicrovascular Disease in Patients with Type 2Diabetes Mellitus and Angiographically NormalEpicardial Arteries”

Sixteen Years in Retrospect: Where Are They Now?

Drs. Raval and Yang join a group of fine physicianswho received Bracco/SCAI research fellowships dur-ing the past 16 years. In special recognition of theanniversary of this important program, the Bracco-ACIST Awards Committee, chaired by Frank J.Hildner, M.D., FSCAI, has compiled a list of theawardees to date:

1988: Steven Hirsch, M.D.; Chaim Lothan, M.D.1989: Thomas H. Marwick, M.D.; Candace Dick, M.D.;

Zina D. Hajduczok, M.D.1990: Timothy A. Shapiro, M.D.; Martha Jane

Senneff, M.D.; Joseph M. Sufton, M.D.

Society Accepting Applications for 2004–05 Bracco-ACIST/SCAI Research Awards Opportunity

New online application process at www.scai.org.Application deadline: January 8, 2004. The Bracco-ACIST/SCAI awards promote investigation of cardiovascular

imaging and invasive techniques, and they foster new insights into patientcare. FROM LEFT Frank J. Hildner, M.D., FSCAI; D. Scott Lim, M.D.; andYerem Yeghiazarians, M.D.

How to Apply

project, titled “MRI Assessment of Load-DependentMechanical Behavior in the Peri-infarct ZoneDuring Post-MI Remodeling,” led to research onconstraining infarct expansion and limiting unfavor-able remodeling using the ACORN jacket device.“As a result of our work, we were selected as thecore laboratory for analysis of MRI data for theUSA-based clinical trial of the ACORN device,which is currently underway,” he explained.

Although only a few years have elapsed sinceDr. Deliargyris received his award in 1999, he, too,found that it was an important step in his career. Hesubsequently completed his general cardiology train-ing and his interventional training, both at theUniversity of North Carolina–Chapel Hill, and thenaccepted an appointment as an assistant professor ofmedicine/cardiology and director of the intravascularultrasound laboratory at Wake Forest UniversitySchool of Medicine. His results of his research proj-ect, titled “Mast Cell Mediators in Coronary ArteryDisease to Evaluate the Role of Mast Cell Mediatorsin Patients with Coronary Artery Disease,” led to fur-ther study and publication in the American Journal ofCardiology and the American Heart Journal.

Both physicians urge young cardiologists toconsider applying for the Bracco-ACIST/SCAI pro-gram. Said Dr. Ferrari: “Don’t be discouraged if youaren’t successful in applying for a grant the first timearound—you’re in good company. The only thingthat will guarantee that a grant won’t get funded isnot to apply for it at all.” ■

7

1991: Andres P. Chodos, M.D.; Neil Clark, M.D.1992: Victor Ferrari, M.D.; Andre Duednckx, M.D.;

Jonathan Reiner, M.D.1993: Spencer Kirk, M.D.;

Paiboon Mahaisavariya, M.D.; Qaiser Rasheed, M.D.

1994: Greg W. Hundley, M.D.; John H. Drury, M.D.;Daniel Krauss, M.D.

1995: Michael V. McConnell, M.D.; Craig H. Scoff, M.D.

1996: Jay Douglas Schlaifer, M.D.; Joel Gellman, M.D.1997: Stephanie G. Cooper, M.D.;

James F. London, M.D.1998: Erik Alfred Eways, M.D.; Gregory M. Lanza, M.D.1999: Efthymios N. Deliargyris, M.D.;

Peter R. Vale, M.D.2000: Eduardo Balcells, M.D.2001: Patricia J. M. Best, M.D.; David Bolon, M.D.2002: Yerem Yeghiazarians, M.D.; D. Scott Lim, M.D.2003: Amish N. Raval, M.D.; Scott H. Yang, M.D.

For this issue of SCAI News & Highlights, theSociety got reacquainted with two awardees fromthe 1990s: Drs. Victor A. Ferrari and Efthymios N.Deliargyris. Both physicians credit the award withhaving a major impact on their careers.

In the 11 years since Dr. Ferrari received hisaward, he completed his training at the Universityof Pennsylvania School of Medicine, quicklyadvancing to become an associate professor of medi-cine in the Cardiovascular Division. His research

Mark Turco, M.D., FSCAI (Washington Adventist Hospital,Takoma Park Md.; on left), and Michael Slack, M.D., FSCAI(Children’s Hospital, Washington, D.C.; on right), were recentguest speakers on “Doc in the House,” a program hosted by Dr. Henry Fishman (center) on WMAL radio in Washington D.C.

Their goal: To increase public awareness of services interventionalcardiologists provide.

Interested in representing the SCAI in your community? Call SCAI headquarters, 800-992-7224, for details.

SCAI Expands Publicity Efforts

8

SCAI Past President Joseph D.Babb, M.D., FSCAI, was recentlynamed chair-elect of theCoalition of CardiovascularOrganizations (CCO), a newentity that brings together 10medical societies that share com-mon goals for professional educa-tion, advocacy, patient education,and development of practice

guidelines. Dr. Babb’s term will begin in early 2003.In the meantime, he and the CCO’s current chair,Dr. Nathaniel Reichek, are working to give thefledgling organization a good start.

“Each of the various cardiovascular subspecialtysocieties has a somewhat different mission, and mem-bers tend to identify most strongly with their ownsubspecialty, but we all share the belief that the needsof our patients will always be our top priority,” saidDr. Babb. “Working together through the CCO will

Dr. Babb Named Chair-Elect of New Cardiovascular Coalition

strengthen the house of cardiology, helping us tospeak with a common voice as we work on initia-tives that will enable all of us to better serve ourpatients.” ■

CCO Member Organizations

The CCO includes representatives from the followingmedical societies:

■ American College of Cardiology■ American Society of Echocardiography■ American Society of Nuclear Cardiology■ Heart Failure Society of America■ NASPE – Heart Rhythm Society■ Society for Cardiovascular Angiography and

Interventions■ Society for Cardiovascular Magnetic Resonance■ Society of Geriatric Cardiology■ Society of Thoracic Surgeons■ Society for Vascular Medicine and Biology

Joseph D. Babb, M.D.,FSCAI

Don’t Miss These Free, Live Online CME EventsHighlights from the Melvin P. Judkins 2003 Cardiac Imaging Symposium

Dates and times are subject to change. Check Web site to confirm schedule.

THURSDAY, AUGUST 7, 2003 7pm–8pm ET• Plaque Recognition with Magnetic Resonance

Angiography—Joao A. C. Lima, MD • IVUS, FFR, and CFR—John McB. Hodgson, MD, FSCAI

THURSDAY, AUGUST 14, 2003 7pm–8pm ET• Radiation Safety in the Cardiac Cath Lab:

The Essentials—Michele F. Loscocco, MS • Angiographic 3-D Reconstruction—John D. Carroll,

MD, FSCAI

THURSDAY, AUGUST 21, 2003 7pm–8pm ET• Digital Imaging Transmission: Telemedicine and

Telecardiology—Jack T. Cusma, MD, PhD• Thermal Imaging and Mapping—Robert S. Schwarz, MD

THURSDAY, AUGUST 28, 2003 7pm–8pm ET• Optical Coherence Tomography—Marc D. Feldman, MD• Digital Imaging in the Cardiac Cath Lab: What Do We

Need? What Do We Have?—Warren K. Laskey, MD,FSCAI

And Coming in September:WEDNESDAY, SEPTEMBER 3, 2003 7pm–8pm ET• E-Debate

Renal Stenting: Do We Need Another Trial?Joseph D., Babb, MD, FSCAI – ModeratorChristopher Cooper, MD, FSCAI, and Christopher J. White,MD, FSCAI

Register for these events and viewinstant replays of previous events at:

http://scai.mebn.netEarly registration is recommended to reserve your seat.

These events are produced in partnership withSCAI and MEBN.NET, a leading publisher ofaccredited CME programs. They are free forSCAI members and are made possible through aneducational grant from Pharmacia.

continued on page 12

9

With this issue, the Society kicks off a new series ofmember profiles, each highlighting the achievements andchallenges of SCAI members in private practice.

SCAI Member Takes InterventionalCardiology to Virgin Islands

When Kendall Griffith, M.D., was a boy growing upin St. Croix, he often heard adults expressing concernabout the island’s healthcare system. Prompted bythose memories, and the sad loss of his 43-year-old sis-ter who died three months after undergoing an LADangioplasty, he resolved to return to the Caribbeanand launch an interventional cardiology program toserve the rather isolated area where he grew up.

Prior to 2000, residents of St. Croix had nolocal access to cardiac interventions. Those whosuffered an AMI received thrombolytic therapy and,in many cases, were flown to the United States forcare. Patients with stable coronary artery diseasealso were flown “off-Island” for intervention. Today,the local population is excited to have a cardiaccath lab available. “There is an air of optimism thathas circulated within the hospital, the local media,and even the government,” said Dr. Griffith.

When he returned to St. Croix is 2001, theisland’s first cath lab had been operational for justover a year. Two resident cardiologists, Drs. MichaelPotts and Dante Galiber, were performing diagnosticprocedures. They had paved the road for Dr. Griffith,but the obstacles ahead were still daunting.

“It was difficult setting up the interventionalprogram for elective and primary PCI without on-site surgical backup. I had to alleviate the fears ofthe staff as well as the medical staff,” he said. “Inaddition, finances were a major constraint.”

He developed consignment agreements with majorvendors, an ambulance service, and Pavia Hospital inPuerto Rico. Now, whenever an elective case is done onSt. Croix, a helicopter is parked at the hospital andPavia’s cardiac surgeon and operating room are notified.For AMI cases, a plane, kept on standby in Puerto Rico,can land in St. Croix in 30 minutes. “Door-to-doortime is approximately 50 minutes,” explained Dr.Griffith, “It took seven months to accomplish this. Wewere able to pull it off because of the hospital adminis-tration, hospitals, doctors, and air ambulance services inPuerto Rico, the local government, the police, fire, andpower companies, and the Virgin Islands emergencymanagement administration.”

After those pioneering days, when every dayseemed to present new obstacles to deliveringJCAHO-standard, CMS-certified quality care, Dr.Griffith’s days have settled into something more rou-tine. He generally puts in a 12-hour day—unless he’son call, in which case he works through the night.He performs about two diagnostic procedures a day,rounds in the six-bed ICU, consults in the ER, readsechocardiograms, and sees 12–15 patients in hisoffice. He also implants permanent pacemakers (pre-viously, residents had to travel to the mainland forthis procedure). “Of course, there are always thesurprise AMIs in the ER, who we can now rush intothe cath lab for primary PCI,” he said with pride.

Dr. Griffith and his colleagues plan to grow theirprogram into the Caribbean’s premier cardiovascularcenter. They are working to make their servicesavailable to cruise ships and the neighboring islands.They have ambitious goals—all centered on deliver-ing the highest-quality care to patients—but thereare still challenges ahead. Those challenges are partof the reason he values his membership in the SCAI.

“I want to be a part of an organization involved inmaking and fighting for policies related to interven-tional cardiology,” he said. “That’s what will help us tomaintain a standard of care that is equal to any otherfacility in the United States.” He views the SCAI asthe source for input, such as “educational services andperformance-improvement policies that will help usgrow our service into something bigger and better.”

The first interventional cardiology program in the Virgin Islands is thriv-ing. Dr. Griffith, who championed this effort, gives much of the credit tohis colleagues and staff. FROM LEFT Dr. Dante Galiber (cardiologist), Dr. Kendall Griffith (director of the cardiovascular lab), Jill Price, R.N.(head nurse), Zanna Gardner, R.N., Lorie Trotman, R.N., Roy Arcamo, PA. BACK ROW Dr. Michael Potts (chief of cardiology).

Member Profile: Kendall Griffith, M.D.

The Society for Cardiovascular Angiography and Interventionsthanks the 26th Annual Scientific Sessions Program Committeefor their dedication and tireless efforts that made the Bostonmeeting the best ever!

THANK YOUSCAI

Bonnie H. Weiner, MD, FSCAIBoston Program Committee Chair

Donald S. Baim, MD, FSCAIBoston Program Committee Co-Chair

Ziyad M. Hijazi, MD, FSCAIBoston Pediatric Program Committee Co-Chair

Robert L. Geggel, MD, FSCAIBoston Pediatric Program Committee Co-Chair

Warren K. Laskey, MD, FSCAIMelvin P. Judkins Symposium Chair

Barry F. Uretsky, MD, FSCAIFundraising Committee Chair

Ted E. Feldman, MD, FSCAIImmediate Past President, SCAI

John McB. Hodgson, MD, FSCAIPresident, SCAI

Joseph D. Babb, MD, FSCAIPast President, SCAI

Mark Reisman, MD, FSCAIProgram Committee Chair

Jonathan M. Tobis, MD, FSCAISan Diego 2004 Program Chair

The Society for CardiovascularAngiography and Interventionsexpresses deep appreciation to the following companies for thegenerous support of its 26thAnnual Scientific Sessions andMelvin P. Judkins Cardiac Imaging Symposium.

TRUSTEE CIRCLEGuidant Corporation

PRESIDENT CIRCLEAventis PharmaceuticalsBoston Scientific CorporationCordis Cardiology

FRIEND CIRCLEBerlex ImagingCeres Medical SystemsJOMED

APPRECIATION ISEXPRESSED TO:

Amersham Health for support of theMelvin P. Judkins Cardiac ImagingSymposium

SPECIAL APPRECIATION IS EXPRESSED TO:

Bracco Diagnostics, Inc.- ACIST for its continued support of the BraccoDiagnostics, Inc. - ACIST/SCAIFellowship Program for Research inCardiac Imaging & Invasive Technology

SUSTAINER CIRCLEAmersham Health

Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership

Medtronic AVE

Millennium Pharmaceuticals, Inc. and Schering Plough Corp.

Pharmacia Corp.

ACHIEVER CIRCLEEli Lilly and CompanySiemens Medical SolutionsThe Medicines CompanyThe University of Texas Medical Branch

SUPPORTER CIRCLEB. Braun Medical Inc.Medcon Telemedicine Technology, Inc.Novoste CorporationJohn Wiley & Sons, Inc.

11

About Guidant

A global leader in medical technology, Guidant pioneerslife-saving cardiac and vascular technology to givepatients another day. Another year. Another lifetime.

As a market leader, we continue to innovate. Youand your patients deserve nothing less. That’s why wecontinue to challenge ourselves, always looking forways to improve our coronary product performance.From a comprehensive line of lesion-specific stents toangioplasty system products like coronary dilatationand guide wires, Guidant will continue to provide youwith excellent products for coronary intervention.

Since the U.S. introduction of the GuidantMULTI-LINK® Coronary Stent System in the fall of1997, Guidant has been a leading innovator in stenttechnology. Great strides in technological innovationhave allowed us to introduce at least one workhorsestent every year. In September 2002, we launched oursixth-generation workhorse stent, the MULTI-LINKZETA™ Coronary Stent System.

The MULTI-LINK ZETA™ system utilizes the sameclinically proven implant as the MULTI-LINK PENTA®,maintaining the benefits of a 17.5 percent binary resteno-sis rate1 and the excellent delivery of the QuickTrack™ST Balloon, with its soft and flexible Pebax material, isdesigned to minimize vessel injury with short tapers andlow stent-to-shoulder. The MULTI-LINK ZETA™ systemis all about confidence: Confidence in acute success andconfidence in long-term clinical outcomes.

Confidence in delivering a stent to small vessels iscrucial as well. That’s why the MULTI-LINK PIXEL™Stent System is designed for tailored performance in smallvessels.* PIXEL’s thin strut, minimum metal design helpsmake the stent highly flexibile, for trouble-free deliver-ability. The PIXEL Registry had a low 8.8 percent targetsite revascularization rate.2

Guidant is also a leader in angioplasty systemsdevices. With market-leading coronary dilatationcatheters, coronary guide wires, and intravascular

1MULTI-LINK PENTA Registry, 6-month data.2MULTI-LINK PIXEL Registry data on file at Guidant.

*In patients presenting with abrupt and threatened abrupt closures.

Important Information from Industry Supporters

continued on page 12

The SCAI greatly appreciates the generous unrestricted educational grant support provided by many industry supporters. This sup-port makes possible high-quality educational programs such as the SCAI Annual Scientific Sessions. The following has been pro-vided for your information by two of those supporters; the content below is solely their own and does not represent the viewpoint ofthe SCAI. Please contact these firms directly for further information.

About Cordis Corporation

As a global leader in the medical device industry,Cordis Corporation continues to be at the forefront ofscience and technology, bringing to the market a widearray of products for vascular disease.

For more than 40 years, the company has fieldedone of the most extensive and dynamic research anddevelopment programs in the industry, receiving morethan 500 patents. Today, the company is proud to havea wide array of significant products for interventionalmedicine, minimally invasive computer-based imaging,and electrophysiology. These products include coronaryand peripheral stents; angioplasty balloons; a full line ofdiagnostic, therapeutic, and guiding catheters; interven-tional guidewires; introducer sheaths; vena cava filters;microcatheters; detachable coils; and much more.

In April 2003, Cordis Corporation received FDAapproval to market its CYPHER™ Sirolimus-elutingCoronary Stent, making it the first drug-eluting stent tobe approved in the United States for the treatment ofrestenosis. With more than 40 clinical trials conductedor in progress, the CYPHER™ Stent remains the moststudied drug-eluting stent today with the largest body ofpublicly presented clinical evidence.

A member of the Johnson & Johnson Family ofCompanies since 1996, Cordis has four divisions/subsidiaries: Cordis Cardiology for cardiovascular diseasemanagement; Cordis Endovascular for the treatment ofperipheral vascular and obstructive diseases; CordisNeurovascular, Inc., for neurovascular management ofstroke; and Biosense Webster, Inc., for electrophysiologyand three-dimensional navigation and medical sensortechnology.

With a deep commitment to customer satisfactionand product efficacy, Cordis continues its pursuit ofproduct excellence, empowering its diverse and experi-enced team of more than 5,300 employees worldwide toreach their highest potential in the name of scienceand medicine. The many physicians, hospitals, andpatients who depend on Cordis deserve this unwaveringdedication to quality.

To learn more about Cordis Corporation, pleasevisit our Web site at www.cordis.com. ■

The Society for CardiovascularAngiography and Interventions9111 Old Georgetown RoadBethesda, MD 20814-1699

NON-PROFIT

ORGANIZATION

U.S. POSTAGE PAID

TELFORD, PA

PERMIT NO. 63

An official publication of The Society for Cardiovascular Angiography and Interventions

SCAI Is Cooking Up anIntellectual Feast

Where: Served in San Diego

When: April 28 – May 1, 2004

Hosted by: Program Committee Chair Jonathan Tobis, M.D., FSCAI

On the Menu:

• Hildner Lecture by renowned interventionalcardiologist Antonio Colombo

• Founders' Lecture by Dr. Paul Yock

• Satellite broadcasts

• Case presentations tailored to practitioners'needs

• Extensive pediatric/congenital heart diseasesymposia

SCAI '04 Promises "Best of the Best"Programming From Start to Finish

SA

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TH

ED

AT

E

Member Profile...continued from page 9

Like many cardiologists “on the mainland,” the biggestobstacle faced by Dr. Griffith and his colleagues relates toMedicare reimbursement. “As it stands, Medicare reimbursesthe hospital on a per-diem basis of $632 per day for hospital-ization greater than 24 hours, and it doesn’t pay for proce-dures done during the hospitalization,” he stressed. “Lessthan 23-hour stays are reimbursed well. In essence, we areable to be reimbursed for elective PCI but not for AMI. Thispolicy is financially draining on the hospital, and it limitsour ability to evolve into an open-heart facility.” ■

Industry Supporters...continued from page 11

brachytherapy, Guidant provides you with a comprehensivepackage to help you perform your coronary interventions.

The GALILEO® III Intravascular Radiotherapy System wasintroduced in the United States in September 2002. TheGALILEO® III Intravascular Radiotherapy System is proven toreduce recurrent in-stent restenosis by 71 percent and combinesthe proven safety of beta radiation with our Centering Catheterand AutoStep™ Technology.

Our passion for innovation is also leading us to excitingdevelopment opportunities—from drug-eluting stents to newtechnologies like cobalt chromium. Keep your eye on Guidant.You’re about to see what we’re made of! ■