www.scai.org September/October 2004

&SCAI NEWSHIGHLIGHTS

The Society for Cardiovascular Angiography and Interventions

Seal of Approval — Proof That SCAI Knows CME . . . . . . . . . . . . . . . . . . . . . . . . . . page 3Good News Abounds for CCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 4SCAI Narrows in on Sensitive Topic — Groin Closure . . . . . . . . . . . . . . . . . . . . . page 13

SCAI ADVOCACY NEWSFLASHReports on Medicare, Practice Expense, and More

In this issue of SCAI News & Highlights, we contin-ue our regular column intended to keep you up to dateon the advocacy issues SCAI is pursuing on behalf of

the membership, the profession, and the patients. Our goalis to give you at-a-glance updates on both progress andproblems, and to point out ways you can help — for exam-ple, by writing a letter, calling your congressional represen-tative, assisting the Society’s Advocacy Committee, partici-pating in an SCAI e-survey, or joining SCAI leaders for avisit to Capitol Hill.

The one constant in advocacy efforts is that strengthlies in numbers, especially if the people who comprise the“numbers” are vocal. SCAI is well over 3,000 membersstrong. Please contact us at info@scai.org if you’d liketo join your voice with those of your colleagues.

Good News on MedicareIn a rare bit of good news from the Centers for

Medicare and Medicaid Services (CMS), interven-tional cardiologists learned that their overallMedicare revenue in 2005 would increase nearly2 percent. This increase results from SCAI-supported Medicare legislation in 2003 that set theannual update for the fee schedule at 1.5 percent(instead of allowing a scheduled payment reductionof approximately 4 percent to go into effect inJanuary 2005) and other technical changes in rela-tive values units sought by SCAI. This increaseexceeds all but one cardiology subspecialty(echocardiography) and is higher than the average

In preparation for the Food and Drug Admin-istration’s (FDA) approval of carotid artery stent-ing this year, SCAI is getting ready on all fronts:

advocacy, education, guidelines, registries, and more.More than ready, actually, because the Society hasbeen quietly working behind the scenes on issues rel-evant to carotid artery stenting with embolic protec-tion for many months. As a leader of a coalition,including the Society for Vascular Medicine andBiology (SVMB), the Society of Vascular Surgery(SVS), and the American College of Cardiology(ACC), SCAI has been responding to a steadystream of requests for information and input fromfederal agencies, all working under tight deadlines.

“SCAI is really at its best in situations like this,

where we’re asked to be bold — totake a position without delay,” saidSCAI President Michael J. Cowley,M.D., FSCAI. “The way we’ve tack-led the issues surrounding carotidartery stenting really highlightsSCAI’s strengths: we’re willing to takea tough stand, we’re happy to workwith other groups, and we moveFAST.”

SCAI: On Call 24/7Indeed, SCAI has been out in front of the ques-

tions surrounding carotid artery angioplasty and

Taking Stands When It Counts

(continued on page 2)

SCAI Leads the Way on Carotid Stenting

(continued on page 8)

Dr. Rosenfield

stenting. Together with its coalition partners, SCAIhas fielded questions from the government aboutwhich physicians should be allowed to perform theprocedure (answer: those who, regardless of specialty,have been rigorously trained), recommended guide-lines for training and credentialing, and advised theCenters for Medicare and Medicaid Services (CMS)on reimbursement (see p. 8 for details on SCAI’smeeting with CMS).

“The background noise on some of our spur-of-the-moment conference calls has been almost comi-cal,” laughed Joseph D. Babb, M.D., FSCAI, whoco-chairs SCAI’s Advocacy Committee with CarlTommaso, M.D., FSCAI. “It’s really a sign of dedica-tion that everyone’s been finding time to call in,even as they’re battling traffic to get home after along day, walking the dog, or getting ready for din-ner with their kids.”

Logging more hours than anyone has been KennethRosenfield, M.D., FSCAI, who chairs SCAI’sCommittee on Peripheral Vascular Disease. He testifiedbefore the FDA, alongside William Gray, M.D., on thepotential of carotid artery stenting in preventing strokeas well as on the critical role that the interventionalcommunity has played in developing and refining theprocedure. He also burned a lot of midnight oil whiledrafting a competency statement in time for the mid-August town-hall meeting called by CMS.

“The bottom line is that this is an intricate pro-cedure that involves the brain, so the training mustbe very rigorous,” said Dr. Rosenfield. “That beingsaid, the ability to perform carotid artery angioplastyand stenting should not be limited to a single spe-cialty. It should be accessible for all who have donethe appropriate rigorous training and preparation.”

At the Table With FriendsThe statement represents the consensus of several

groups, not just SCAI, stressed CCI Editor-in-ChiefChristopher J. White, M.D., FSCAI, who noted inhis recent editorial “The Mother of Turf Wars:Carotid Stents” that at least “seven different anddistinct specialties may seek hospital privileges toperform carotid angiography and stent placementwith distal protection.”

Among those seven specialties are at least threegroups — ACC, SVMB, and SVS — that havebeen working side by side with SCAI to advocatefor decisions that will best serve the thousands ofpatients whose lives could be saved, or quality of lifeimproved, if they underwent carotid artery angio-plasty and stenting. It has been estimated that theprocedure could benefit approximately 200,000

Americanseach year, people whootherwise would not be candidatesfor stroke-prevention treatment.

Many of these patients come to the attention ofcardiologists because they are being treated for co-morbid conditions that make carotid endarterectomya high-risk option at best. For this reason, noted Dr.Rosenfield in his testimony to the FDA, the cardio-vascular community has championed the procedureand is now advocating that the appropriate patients— those whom clinical trials, have shown to benefit— have access to it. The best way to remove unnec-essary barriers, he stated, is to ensure proper trainingof physicians who wish to perform the procedure, tosystematically monitor outcomes during the post-market phase of roll-out, and to develop mechanismsfor continuous quality improvement.

Supporting the PractitionersSuch a statement is exactly the kind of thing that

rank-and-file practitioners need, said HowardFeldman, M.D., FSCAI, who recently joined SCAI’sCommittee on Peripheral Vascular Disease for theexpress purpose of helping physicians who, like him,have been “flogging in the trenches politically.” Heexplained that he thinks SCAI is “the natural agentto create some common ground between cardiolo-gists and groups that feel they are being robbed of aprocedural birthright.”

Carotid artery angioplasty and stenting reallyspeaks to the “vascular” in cardiovascular, noted Dr.Cowley. “As a group, interventional cardiologists areuniquely trained to steer a catheter, and our patientsare so often the best candidates for this procedure.

“You don’t often see an issue thatapplies so universally to SCAI’s mis-sion,” Dr. Cowley continued. “Themedical community needs guidelineson this procedure, so we’re workingfuriously to write them; our mem-bers need someone advocating fortheir right to perform this proce-dure, and we’ve been in the thick of

6/21 Advocacy Committee conference call

6/28 Executive Committee conference call

7/1Conference Call7/7Conference Call

7/16 Conference Call- address training in carotids

7/11Conference Call7/12 Meet at

CMS headquarterswith SVMB and ACC

7/28Conference Call- address carotids competency

C A L E N D A R

C A L E N D A R

7/13Conference Call- follow-up strategy

2

Dr. Cowley

Carotid Stenting (continued from page 1)

3

Following the rigorous evaluation process conduct-ed every four years by the Accreditation Councilfor Continuing Medical Education (ACCME),

SCAI has again been awarded accreditation as aprovider of continuing medical education for physicians.

The Society has maintained its accreditation since1993, when Joseph D. Babb, M.D., FSCAI, in conjunc-tion with Rita Watson, M.D., FSCAI, and CarlTommaso, M.D., FSCAI, worked tirelessly to meet thestringent requirements of the ACCME, which evalu-ates an institution’s overall CME programs according tostandards adopted by the Council’s seven sponsoringorganizations.

For the next decade, Dr. Babb served as chair of theSociety’s CME Committee and saw to it that SCAIcontinued to meet the requirements of the ACCME.Ted Feldman, M.D., FSCAI, then joined the committeeas co-chair. They were ably assisted during this year’sevaluation by SCAI’s CME expert Anne Marie Smith.

“ACCME accreditation is like the GoodHousekeeping seal of approval — a recognizable mark of

approval for the consumer,” said Dr. Babb. “Since pro-fessional education and advocacy are among theSociety’s most vital mission areas, it would be unthink-able for us to let our ACCME accreditation lapse. Weview it as essential to achieving our education mission.”

The reaccreditation process is important, too, addedDr. Babb. “In the process of examining your entire edu-cational program, you are forced to be objective andyou are able to identify how the organization hasevolved since the last evaluation. The process itselfhelps you improve your programming.”

The reaccreditation process involved a “self-study”program designed to review the content of the Society’sCME offerings and to assess members’ needs. Theprocess took almost two years and involved hard workfrom the self-study committee. SCAI partnered withthe ACC to review program content and the needs ofthe cardiovascular community. Members were surveyedto ascertain their real CME needs and goals. “The self-study process highlighted the importance of maintain-ing the unbiased, practical, and current content of ourAnnual Scientific Sessions,” said Dr. Feldman. “Theend result of the process was a four-year recertification.”

Certainly, the numbers demonstrate that SCAI isdoing things right. Since its last accreditation, member-ship has doubled (now over 3,000), and attendance atthe flagship event, the Annual Scientific Sessions, con-tinues to grow at a pace that keeps things bustlingwithout being too busy for people to get reacquaintedin peace. n

SCAI Awarded ACCME Reaccreditation Status

Dr. Babb Dr. Feldman Ms. Smith

the debate for months now; and there’s going to bean ongoing need for education in this area — we’vegot that covered, too.”

In this last regard, he points to a host of SCAI edu-cational tools physicians can turn to, starting withcourses such as the 36th Annual CardiovascularConference at Snowmass, which SCAI is sponsoring andthe ACC is cosponsoring (see p. 12 for details) as wellas two programs SCAI is cosponsoring this comingspring: Current Evaluation and Management of Extra-Cranial Carotid Disease: The Status of Carotid Stenting,directed by Dr. Gray, and Peripheral Angioplasty and AllThat Jazz, directed by new SCAI Trustee Stephen R.Ramee, M.D., FSCAI. And, of course, there is Dr.White’s expertise in this area. Not only is CCI the bestsource for updates on the procedure as well as “how-to”case reports, but Dr. White has for years held his popu-lar peripheral vascular disease symposium at the SCAI

Annual Scientific Sessions.SCAI is also helping to teach the public about

the role that carotid angioplasty and stenting canplay in their health. The day after the RXACCULINK? Carotid Stent System and RXACCUNET? Embolic Protection System wereapproved was approved by the FDA, the Society dis-tributed a news release and educational fact sheet toan extensive list of medical reporters. In these docu-ments, SCAI applauded the FDA's decision andnoted that this life-savingprocedure should be avail-able through physicians who, regardless of specialty,are appropriatelytrained and credentialed. Both ofthese documents are available at scai.org.

“SCAI has been working ‘round-the-clock onthis issue, and we’ll continue doing just that to getthe best results for our members and their patients,”concluded Dr. Cowley. n

It’s just a tool for ranking journals. Correction: It’s the tool. It’s thetool that the Institute for

Scientific Information (ISI) uses tomeasure impact— which, in a word,means how often a journal is citedand, therefore, how important it isto the field. It’s the tool that churns

out numbers called impact factors. Andthose are the numbers that many an editor-in-chiefloses sleep over.

But not the editor-in-chief of SCAI’s journal:Catheterization and Cardiovascular Interventions. No,Christopher J. White, M.D., FSCAI, has a very relaxedattitude about CCI’s impact factor. While Dr. Whitewon’t deny that he was pleased when publisher JohnWiley & Sons announced that CCI’s impact factor

had climbed from 1.074 to 1.519 in 2003, the Journal’sISI impact factor simply isn’t his top priority.

“Our focus is on quality,” he explained. “Over thepast three years of my editorship, we have focused onimproving the scientific quality of the manuscriptswhile preserving access for the practical ‘how-to’ casereports that are the lifeblood of the Journal.”

In other words, although Dr. White may be grati-fied that, according to impact-factor data, more peo-ple are reading his journal and more people are citingits articles, the bottom line for him is “making surethat the Journal is relevant to the daily practice ofthe invasive adult and pediatric cardiologist.”

Ironically, CCI’s emphasis on the “how-to” casereports that are so useful to practitioners could lowerthe infamous impact factor. That’s why it’s all themore meaningful that the Journal’s impact factor rose

Dr. White

(continued on page 7)

CCI Scores High on Measure of Journal Quality

an unprecedented amount last year. Dr. Whiteexplained: “We have not ‘tried’ to improve the impactfactor because case reports are never cited, whichtranslates into a weakened impact factor.”

Except that, in CCI’s case, it didn’t. Here’s why,again in Dr. White’s words: “The fact that our impactfactor has risen, despite continuing to include casereports, reflects more citations and increased readershipof the high-quality papers that we publish.”

It also may be an extension of the efforts of Dr.White and his edito-rial group to broadenthe Journal’s reader-ship to include inva-sive cardiologistsinterested in periph-eral vascular disease(an area that is amajor interest for Dr.White) while pre-serving its long-timecore readership bypediatric and adult interventionalists.

More Good NewsThere’s more evidence of CCI’s increasing impor-

tance in the field of cardiovascular medicine. First, the Journal now ranks in the top third of

cardiac and cardiovascular systems journals, as calcu-lated by the ISI.

And, second, more and more medical journalistsare reporting on the studies published in CCI. Theresult has been increasing visibility for the Societyand the Journal among professional and consumeraudiences. This outcome is partially the result ofefforts by SCAI Public Relations Committee Chair J. Jeffrey Marshall, M.D., FSCAI, to drum up publici-ty for the Society and the field. Each month, withDr. White’s help, Dr. Marshall’s team distributesnews releases to an extensive list of trade and main-stream reporters. To check out some recent newsreleases distributed by your Society, visit thePressroom at scai.org. You’ll be among good company— some highly regarded journalists check out thesite each month and they have quoted SCAI andCCI in print, radio, television, and on the Internet.

And Easier Access, Free to SCAI MembersStaff from SCAI and John Wiley & Sons recently

put their heads together to make it much easier and

convenient for Society members to access CCIonline. No longer do members need to have theirmember number handy. Nor do they have to log intwice, once at scai.org and a second time on Wiley’sWeb site.

Instead, just bookmark www.scai.org, click on“Publications,” and log in. In no time, you’ll be read-ing CCI online and downloading the articles thatinterest you most. n

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

9111 Old Georgetown Road, Bethesda, MD 20814-1699Phone 800-992-7224; Fax 301-581-3408; www.scai.org;

info@scai.org

Michael Cowley, M.D., FSCAIPresident

Morton Kern, M.D., FSCAIEditor in Chief

STAFF

7

Number of articles published in CCI in 2002 and 2001Citations in 2003 to CCI articles published in 2002 and 2001 = Impact factor

CCI (continued from page 4)

Calculating Impact FactorFor those who can’t resist a bit of trivia or those fascin-

ated by the behind-the-scenes business of scientific journals,here’s some more information about the impact factor, ascalculated annually by the Institute for Scientific Information,or ISI. The equation looks something like this:

Norm LinskyExecutive Director

Bea ReyesDirector, Administration

Rick HenegarDirector, Membership

and Meetings

Kathy MizaniMembership Coordinator

Betty SangerSponsorship and

Development

Kathy Boyd DavidManaging Editor

Touch 3Design & Production

Diversified Publishing ServicesPrinting

Anne Marie SmithEducational Programs

Accessing CCI is EASY

1. Bookmark www.scai.org.2. Click on “Publications.”3. Log in using your personalized user name and

password. (Check out the tips on p.13 to createan easy-to-remember user name and passwordall your own.)

8

for all physicians. Thanks in large part to the estab-lishment of SCAI’s aggressive advocacy program in2000, this year is the third in a row where wehave good news to report.

Although these CMS estimates could varyaccording to a physician’s geographic location orpractice mix, the increases were welcome news, saidAdvocacy Committee Chair Joseph Babb, M.D.,FSCAI. “We are very pleased that SCAI’s advocacyefforts have delivered a positive result for the mem-bership,” said Dr. Babb. “For the past two years, wehave faced potential reductions in Medicare reim-bursement for interventional procedures. Each time,working with our colleagues in cardiology and with other medical societies, we have been able to per-suade Congress and CMS to set aside the reductionsin favor of modest improvement. I appreciate the contributions of so many of the members who tookthe time to contact their congressional representa-tives in support of more sensible, rational payment.SCAI will need their help in 2005 as Congressrevisits the issue of physician payment.”

Some of the other provisions in the proposed physi-cian fee schedule for 2005 include the following:

• For all newly enrolled Medicare beneficiaries,Medicare will provide coverage for an initial physicalexamination, including an electrocardiogram. Untilnow, routine physical examinations were not coveredby Medicare.

• Another new preventive service that will becovered beginning in 2005 is a cardiovascularscreening blood test consisting of a total cholesteroltest, a test for HDL, and a triglycerides test.Additional cardiovascular screening tests may beadded in the future.

Progress on Practice ExpenseSCAI has again demonstrated that perseverance

pays. The Centers for Medicare and MedicaidServices recently notified SCAI that it has accepteddata gathered through a practice-expense surveyfunded by SCAI, ACC, and other cardiovascularsocieties. These data show that the average hourlypractice expenses for cardiologists are in fact muchhigher than the current data used in the Medicareformula. Although the CMS has indicated that itneeds to resolve several policy questions related tocalculating payment for technical components ofcertain cardiology procedures, SCAI is cautiouslyoptimistic that all of the cardiology subspecialties

will see an increase in their practice expense pay-ments in the future. When this happens, it will bethe second time since the SCAI advocacy programwas fully established that progress was made onmembers’ behalf to fix the practice expense problem.

SCAI presented compelling data correctingCMS’s incorrect assumption that clinical office staffhad no involvement in catheterization services per-formed in the hospital. CMS reviewed the data andagreed that clinical office staff provide meaningfulsupport for such services, including scheduling thelab and the equipment, obtaining prior approval andinformed consent, and conveying patient instruc-tions. The practice expense values have since beencorrected.

Be assured — your Society intends to continuemonitoring and pursuing the practice expense issuecarefully. Your concerns will continue to be voiced,through your Society, until it is resolved.

Pre-empting Questions About Carotid Stenting Reimbursement

Four SCAI leaders dropped everything for animpromptu meeting with CMS Director of CoverageSteve Phurrough, M.D., on the subject of reimburse-ment for carotid artery angioplasty and stenting.SCAI President Michael J. Cowley, M.D., FSCAI,Past Presidents Ted Feldman, M.D., FSCAI, andJoseph D. Babb, M.D., FSCAI, and SCAI PeripheralVascular Disease Committee Chair KennethRosenfield, M.D., FSCAI, were flanked by represen-tatives from the Society for Vascular Medicine andBiology, the Society of Vascular Surgery, and theAmerican College of Cardiology.

CMS has made it clear that its decision-makingprocess for reimbursement of carotid stenting is thedawn of a new era at CMS. As critical new tech-nologies are introduced, this new process involves,simply put, MORE. More rigorous analysis, more tes-timony, more data, much more careful review thanever. CMS has also made it clear that it earnestlyseeks this input from professional societies, and itwill listen carefully.

In response, your colleagues listed above and staffworked intensively to provide the input CMSrequested during that impromptu meeting. WhileCMS appreciated the information, all SCAI repre-sentatives agreed that this was simply the first step inwhat will be “a marathon, not a sprint.” We willkeep you posted as events unfurl. n

(continued from page 1)

SCAI ADVOCACY NEWSFLASH

10

Dr. Manu Rajachandran, MD, FSCAI,FACC, joined Deborah Heart Institute inBurlington, N.J., five years ago to launch a

peripheral vascularization program. At that time,the Institute was doing a mere 10 endovascular pro-cedures a year, said Dr. “Raj” — as he is known atDeborah and elsewhere.

“Since I was tapped to take the helm, that figurehas increased tenfold,” he said, adding that he and histeam are continuing to grow the program, in part bytackling a new, and perhaps greater, challenge. He isdetermined to mitigate the turf conflict betweeninterventional cardiologists and vascular surgeons.

“I’d like to play a role in seeing the disciplineswork together to provide seamless care with mini-mal competitiveness,” he explained.

Bringing the Players TogetherHis vision of an interdisciplinary approach is pri-

marily what brought Dr. Raj to SCAI. “I thought thatby working with the great luminaries I could learnabout policy and advocacy and help promote the con-cept that interventional cardiology and peripheralvascular intervention go hand in hand,” he said.

As a member of the Society’s Credentials andAdvocacy committees, he is working with col-leagues to realize this goal. “Supporting catheter-based therapy has been the Society’s first steptoward promoting the role of interventional cardiol-ogists in peripheral vascular intervention,” he said.

Dr. Raj trained in interventional cardiology atMiami Heart Institute. In 1996, it was on to St.Elizabeth’s Medical Center of Tufts School ofMedicine in Boston for a fellowship in vascular

medicine and peripheral vascular intervention. Atthe time, there were only two programs in the coun-try focused on this discipline.

Interlacing Two CulturesA native of Madras, India, Dr. Raj came to the

United States when he was seven years old. By theseventh grade, he had become enamored with theidea of using hands-on skills to dramatically affect aperson’s life and had decided he wanted to be a physi-cian. Today, his approach to his patient care reflectsan interlacing of Indian and American cultures.

“For example,” he said, “one strong carryoverfrom India that has resonated throughout my careerhas been ‘respect’ — respect for my colleagues, mypatients, and all people as human beings.”

American culture has influenced Dr. Raj, too.“Americans have a kind of swagger, which is a goodtrait for a surgeon,” he explained. “You need a per-sona that says, ‘Hey, we can take care of this.’ Thisquality gives the patient and your colleagues confi-dence in you as an operator,” he said.

Both attitudes have served Dr. Raj at Deborah,especially as he works to develop an interdiscipli-nary model that combines the talents of interven-tional cardiologists, vascular surgeons, and radiolo-gists to advance the concept of a comprehensivecardiovascular center.

Success Is SweetIt seems Dr. Raj is entitled to some of that swag-

ger. Working together, his team has seen a sweepingincrease in volume with minimal mortality and mor-bidity. “We are treating very sick people and haven’tlost one patient yet,” he said.

Dr. Raj is, of course, proud of that fact, but his con-tact with certain patients really drives home theimportance of what his team is doing. He recalls onepatient with critical ulcerative vascular disease of herleg. The vascular surgeons in her community saidthere was a 50 percent chance that the leg could besaved with bypass and were discussing amputation.

“We ballooned open the totally occluded arteryin multiple spots and put the stents in. Once theulcers healed, there were tears in her eyes,” he said.“This is what you live for — the immediate gratifi-cation that comes from being able to restore a per-son’s quality of life.” n

IN THE TRENCHES

“I’m the guy in the civilian clothes,” said Dr. Rajachandran, who was joined forthis photo by the members of the interdisciplinary team he has assembled atDeborah Heart Institute.

Cardiologist Bridges Cultures and Specialties

The high rate at which membersresponded to SCAI’s latest e-survey, on groin closure, was

nothing short of astonishing, accord-ing to Bonnie H. Weiner, M.D.,FSCAI, who designed the survey andis currently analyzing the feedback.

“Over 20 percent of our memberswith e-mail responded, which points to two

things: First, in today’s health care environment, weall need to be looking at costs, risks, workforce use,and so forth,” said Dr. Weiner, “And, second, theresimply aren’t a lot of good data on the issues sur-rounding groin-closure devices.”

SCAI may be the answer to the second dilemma.The data collected from its simple, seven-question e-survey could be the first step toward some clarifica-tion in the controversial area of groin closure. Inaddition to indicating members’ interest in the sub-ject, the survey results also reveal that respondentsare using these devices for a number of reasons,

including to facilitate early ambulation and discharge(86%), for patient comfort (78%), for safety (26%),

and to achieve cost savings (7%). There was some good news embedded in the data,

too, said Dr. Weiner. “I was really pleased to see that63 percent of labs track outcomes,” she explained.

“That dispelled some of my early concerns — forexample, that no one knew what was going on oncepatients left the cath lab.”

And what makes that finding even more encour-aging is that 60 percent of respondents whose labstrack outcomes said they would be willing to sharethose data with a multicenter registry. Echoing theremarks of several respondents who made notationsin the write-in section of the survey, Dr. Weinerstressed that SCAI is the type of organization thatshould take the lead in such a registry.

That’s the next step, she said — to analyze thedata further, perhaps do a follow-up survey, and thenperhaps develop a short, voluntary registry. “Doingthat would enable us to get an even better sense ofwhat’s going on in the field and what the real ratesof complication are,” she concluded.

Dr. Weiner welcomes more feedback from SCAImembers. Send your comments to info@scai.org. n

13

SCAI Groin-Closure e-Survey Fills Void

Dr. Weiner

Would You ShareData for a

MulticenterRegistry?

No– would not share data

Yes– would share

data

33%

7%

60%N/A– data not tracked

Does Your LabTrack Outcomes

of ClosureDevices?

23%

13%

63%

Don’t Know

No Tracking

Yes, we trackoutcomes

Let’s face it — most of us are burdened with toomany user names and password combinations.It’s nearly impossible to keep track of them all.

To help SCAI members, the Society has made iteasy to customize your user name and password sothat you can easily access the wealth of contentavailable to members only on scai.org.

Here’s how you can customize things for quickentry into the members’ area of the site, whereyou’ll find the slide library, proceedings from theAnnual Scientific Sessions and other meetings,access to CCI, and more:

1. Log in using your last name and SCAImember ID.

2. Click your name, which will appear as a link

in the upper-right corner of the screen. 3. The next screen will contain all of your perso-

nal information. At the bottom of that screen,you’ll see two fields — “Login Username” and“Login Password.” Enter a friendly usernameand password in these fields, and then click“Update.”

Once you’ve completed this simple process, you’llbe able to use either of two rather easy approachesto the members’ portion of scai.org:

1. Your last name and SCAI ID number, or2. Your newly customized user name and password.This tip was provided by Karl Wilkens, president of

CME Development Group in Cleveland, who designedSCAI’s new Web site. n

SCAI.ORG TIPS OF THE MONTHFriendlier Passwords

14

OfficersMichael J. Cowley, M.D., FSCAI

President

Barry F. Uretsky, M.D., FSCAIPresident-Elect

John McB. Hodgson, M.D., FSCAIImmediate Past President

Carl M. Tommaso, M.D., FSCAITreasurer

Gregory J. Dehmer, M.D., FSCAISecretary

...And Welcome Aboard – Really!

Randy K. Bottner, M.D., FSCAISavannah Cardiology

Savannah, GA

Stuart T. Higano, M.D., FSCAITown & Country Cardiovascular

GroupSt. Louis, MO

John M. Lasala, M.D., Ph.D., FSCAIWashington University School of

Medicine/BarnesSt. Louis, MO

Hugo Londero, M.D., FSCAIInstituto de Cardiologia

Cordoba, Argentina

Michael R. Mooney, M.D., FSCAIMinneapolis Heart Institute

Minneapolis, MN

Albert E. Raizner, M.D., FSCAIThe Methodist Hospital

Houston, TX

Good-byes are never easy, but they’re not too bad for SCAI Board members whose terms have come to anend. That’s because all SCAI members know that their input, expertise, and assistance are always wel-comed … and often sought with just a moment’s notice. The Board members listed below, whose terms

wrapped up at SCAI ’04, can attest to the importance of rapid response, especially as the Society tackles impor-tant advocacy issues, such as restoring fair reimbursement to cardiologists.

SCAI THANKS EACH OF THESE FELLOWS FOR YEARS OF DEDICATED SERVICE ON ITS BOARD.

The Society is pleased to welcome the following officers and trustees. SCAI extends its thanks, in advance, tothese Fellows for the time and talent they will contribute to the Society during their terms.

New Trustees

Steven R. Bailey,M.D., FSCAI

University of TexasHealth Sciences Center

San Antonio

Raoul Bonan, M.D.,FSCAI

Montreal HeartInstitute

Montreal, Canada

George D. Dangas,M.D., FSCAI

Lenox Hill Heart andVascular InstituteNew York City

Lloyd W. Klein, M.D.,FSCAI

Rush Medical Center/Gottlieb Memorial Hospital

Chicago

William K. LaFoe, M.D., FSCAICardiovascular Consultants of Cape

GirardeauCape Girardeau, MO

Douglass A. Morrison,M.D., Ph.D., FSCAI

Tucson VATucson, AZ

Stephen R. Ramee,M.D., FSCAIOchsner Clinic

New Orleans, LA

Mark Reisman,M.D., FSCAI

Swedish HospitalSeattle, WA

Larry S. Dean, M.D.,FSCAI

University of WashingtonSeattle

Good-Bye...Well, Not Really

Nominating Committee Member-at-Large

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T ime is a precious commodi-ty for everyone in today’sworld, but even more so for

interventional cardiovascular spe-cialists. As we grapple with theexplosive growth of technology anddevices as well as ever-increasingpatient volume, we become moreand more vulnerable to the effectsof time constraints in the catheteri-zation laboratory. Juggling the artis-

tic and the scientific sides of our practice along withthe reality that there is indeed a business side isoften difficult — and frequently elusive. Here are afew examples of situations in which the business ofinterventional cardiovascular medicine can throwthe art and science of the specialty off course.

The art of coronary angiography is in visually esti-mating the severity of coronary stenosis. This art hasstood the test of time. Studies have shown both reli-ability and accuracy in such assessment when it isperformed by well-trained and experienced interven-tionalists. The science of coronary angiography is inperforming all of the required orthogonal angles,using intravascular ultrasonography (IVUS) whenconventional contrast angiography fails to reliablyshow a stenosis, when a moderate-grade angiograph-ic stenosis exists with compelling clinical presenta-tion, or when there is a “Mach effect” — due to ves-sel overlap — that precludes accurate lesion assess-ment. The business of coronary angiography intrudeson the art and the science when a physician feelspressured to perform a procedure hastily withoutmultiple orthogonal views, to judge and report dis-ease severity and extent with an intent to revascular-ize, or to avoid IVUS use to complement contrastangiography findings merely because of the extra timeit takes to perform an IVUS procedure and analysis.

The art of valvular disease assessment lies in con-ducting a thorough physical examination of a patientreferred to the invasive cardiovascular laboratoriesfor valvular or congenital heart disease evaluation, insuspecting intracardiac shunts as the underlying eti-ology of dyspnea or fatigue, and in correlating symp-toms to a disease state and objective findings. Thescience of valvular/congenital disease evaluation is inthe use of appropriately calibrated pressure transduc-ers, in persevering through painstaking measure-ments from appropriate anatomic locations, and inmaintaining a thorough understanding of the pitfalls

of various invasive and noninvasive modalities. Thebusiness of valvular/congenital disease assessmentinterferes when one performs only coronary angiog-raphy when a comprehensive right- and left-heartcatheterization is called for, when one avoids per-forming detailed and accurate shunt oximetry runs,and/or when one uses computer-generated pressurevalues without manual over-reads.

The art of coronary intervention lies in under-standing the limitations of devices, patient sub-strates, and operator factors before embarking on arevascularization strategy and in devising novelapproaches to complex anatomic and clinical prob-lems. The science of coronary intervention lies inunderstanding the hazards of radiation from long andmultiple complex procedures to both the patient andthe clinician, in judiciously using state-of-the-arttechnology to achieve maximal clinical gain withminimal risk to the patient, and in employing physi-ologic information obtained from Doppler or thepressure-wire when making clinical decisions. Thebusiness of coronary intervention obstructs the artand the science when percutaneous revascularizationis performed when a surgical approach is called for,when one fails to refer a patient for alternative ther-apeutic approaches after conventional percutaneousinterventions have provided insufficient symptomrelief, when one intervenes on a moderate-gradecoronary lesion without physiologic confirmation offunctional significance, or when thrombolytic thera-py is prescribed for an after-hours myocardial infarc-tion even though the optimal therapy is primarycoronary angioplasty.

Yes, most of us are part of the medical businessenterprise in one capacity or another, but we mustnever lose sight of the fact that our patients rely onus to be, first and foremost, practitioners of the artand the science of cardiovascular medicine. It isincumbent on all of us to keep the art of our disci-pline thriving and the science of cardiovascular inter-vention at the forefront of progress in cardiovascularcare. A humble appreciation of human nature and itsfollies, along with periodic reevaluation of our ownindividual approach to the practice of interventionalcardiology, will help each of us to keep the businessside of patient care in its proper place. n

The Art, the Science, and the Business of Interventional Cardiology

Vijay G. Kalaria, M.D.,FSCAI

Krannert Institute ofCardiology

Indiana University,Indianapolis