In This Issue:
CCI Editor's Choice: Long-Term Outcomes of DES in In-Stent Restenosis
The February 2014 issue of Catheterization & Cardiovascular Interventions (CCI) is now available online. Headlining this issue is the Editor's Choice article, "Comparative effectiveness of drug-eluting stents on long-term outcomes in elderly patients treated for in-stent restenosis: A report from the National Cardiovascular Data Registry."
CCI Editor-in-Chief Steven R. Bailey, MD, FSCAI recently discussed this study's implications for the treatment of in-stent restenosis in elderly patients with lead author Michael A. Kutcher, MD, FSCAI. Drs. Bailey and Kutcher also share how other interventionalists can access NCDR data for their own research. Click here to watch this discussion.
Also, be sure to review original studies and accompanying editorial comments on the prognostic value of bleeding after PCI in elderly patients, comparative outcomes of small coronary artery stenting from the NHLBI Dynamic Registry, PCI for ACS due to graft failure, and balloon-assisted tracking. Not to be missed are several case reports in pediatric interventions and Mitraclip.
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SCAI-PAC Report From Capitol Hill: Assessing the Future of the SGR
Over the last two weeks, SCAI-PAC Director Wayne Powell has talked with more than a dozen key Congressional leaders and/or their staff about the status of the sustainable growth rate (SGR). Mr. Powell and colleagues from the Alliance of Specialty Medicine visited Capitol Hill to assess how the current SGR-repeal bills are faring and their prospects for passage during the current three-month “patch” period.
“As a result of the patch that was passed in late 2013, physicians are not suffering the fee cuts that had been slated to go into effect Jan. 1,” said Mr. Powell, “but the clock is ticking. We are concerned about what will happen when the patch ends, especially if there has been no action on any of the three bills that have passed through their committees. They must be combined before they could be enacted into law.”
The signals from elected officials and their teams suggest that consensus can be achieved on how to repeal the SGR and develop a more value-based payment system, but agreement seems out of reach on how to pay the $150 billion associated with the repeal. Some are pushing to get a bill passed before Senate Finance Committee Chair Max Baucus (D-MT) assumes his new post as ambassador to China.
“The new Committee Chairman is likely to be Sen. Wyden (D-OR), and he may have new ideas that could slow this process down,” said Mr. Powell. “Given the gridlock this Congress has struggled with on budget issues, some on the Hill are predicting they will enact a nine-month patch with the possibility of revisiting a true SGR fix during the lame-duck period between the November 2014 elections and a new Congress forming in January 2015.”
In preparation for visiting Capitol Hill, SCAI and its Alliance partners provided elected officials with a summary of their position on replacing the SGR with an improved model for Medicare fees. In short, SCAI believes that a 10-year freeze in physician payments is wholly unacceptable and that any new payment system must allow physicians “to make investments in meaningful and relevant care delivery models that aim to improve quality and efficiency and foster patient access to the physician of their choice.”
Read the Letter
Stay Up to Date on SCAI-PAC Activities and Learn How You Can Help
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Which Comes First — Hemodynamic Support or PCI?
In the latest Eye on Intervention blog, Michael S. Lee, MD, FSCAI, describes a challenging clinical scenario where there were no clinical trial data to turn to. The patient – a woman suffering STEMI and cardiogenic shock – was in extemis and a decision needed to be made: proceed with the PCI or start with a hemodynamic support device?
Dr. Lee describes his thought process and the course of action he prefers, and he invites the input of the interventional cardiovascular community. Where do you start when facing a challenging case like this one? What factors influence your decision?
Join the Discussion Now!
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SCAI 2014: CHD Track to Bring Back Debate- and Case-Based Favorites
In addition to a focus on analyzing the essential balance act between innovation and regulation, the Congenital Heart Disease (CHD) Track at SCAI 2014 will also be highlighted by tried-and-true interactive favorites.
Attendees hankering for a free-wheeling discussion will want to join the Debate session “Deficient Retroaortic Rim Is an Absolute Contraindication to ASD Closure with the ASO Device.” “Are there clear echo-based contraindications to device closure of ASDs?” asked SCAI 2014 Congenital Heart Disease (CHD) Program Chair Matthew J. Gillespie, MD, FSCAI.“Bring your opinions to the debate session. It’s sure to be a lively discussion.”
SCAI’s educational gold standard―case-based sessions, including Brainscratchers and I Blew It sessions―will be heavily featured throughout the conference and highlight exceptionally challenging cases, problems, and mistakes to stimulate discussion and peer learning. “We kick-off the CHD Symposium on May 28 with a Brainscratchers session, which is a great way to begin the symposium because it always leads to active participation from the audience -- one of the most important hallmarks of the SCAI meeting,” says Dr. Gillespie.
The CHD program will also provide the Lightning Rounds forum for study updates on the latest trials in congenital interventional cardiology: GORE Septal Occluders, COAST 1 and 2, Sapien devices and AMPLATZER Duct Occluder.
Enroll for SCAI 2014 Now! SCAI Members Save $300 Off Regular Tuition
Don't Forget to Make Your Reservations at Caesars Palace Las Vegas
More on the CHD Track's Focus on Balancing Innovation and Regulation
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SCAI-QIT Tip of the Month: Protecting Kidneys Starts Before Procedure
Patients who develop CIN are at an increased risk of death or myocardial infarction.
Risk score (pre-procedural) calculation for CIN (consider online CIN-risk calculators)
Evaluate post-procedural (48 hour) renal function in high-risk patients
Nephrotoxic meds (Review/Adjust) and account for recent contrast exposure
Adequate hydration (Start 3-4 hours before and continue 6-8 hours post-procedure)
Limit contrast use (aim for maximum contrast volume of 3.7 x eGFR)
Take RENAL precautions for patients at risk for CIN. Make Pre- and Post-procedure renal evaluation and hydration mandatory.
- Schweiger MJ, Chambers CE, Davidson CJ, et al. Prevention of contrast induced nephropathy: recommendations for the high risk patient undergoing cardiovascular procedures. Catheter Cardiovasc Interv. 2007 Jan; 69(1):135-40.
- Sample Online CIN Risk Calculators:
- Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced-nephropathy after percutaneous coronary intervention: Development and initial validation. J Am Coll Cardiol 2004; 44:1393–1399.
The SCAI Quality Improvement Toolkit was developed with support from founding supporter Daiichi Sankyo, Inc. and Lilly USA, LLC and AstraZeneca. The Society gratefully acknowledges this support, while taking sole responsibility for all content developed and disseminated through this effort.
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Call for Nominations to SCAI Board of Trustees & Executive Committee
SCAI is seeking nominations for the Board of Trustees (BOT) and other positions.
PROCEDURE: SCAI encourages all members to send nominations to the Nominating Committee for consideration. You can nominate any SCAI Fellow (FSCAI) in good standing (including yourself if you wish). The Nominating Committee will then forward its recommendations to the BOT informationally, and to SCAI Fellows, Senior Fellows and Emeritus Fellows prior to the SCAI 2014 Scientific Sessions this May in Las Vegas. All Fellows, Senior Fellows and Emeritus Fellows present at the SCAI Annual Business Meeting in Las Vegas will vote on these recommendations. Nominations from the floor will also be accepted during the business meeting.
POSITIONS: Nominations are solicited for the following positions:
- Trustee: Three slots, for the term May 2014 – May 2017
- Secretary: One slot (member of the Executive Committee), for the term May 2014 - May 2015
- Treasurer: One slot (member of the Executive Committee), for the term May 2014 - May 2020
- At-large Member of the Nominating Committee: One slot, for the term May 2014 - May 2017
This year's Nominating Committee consists of:
- Christopher J. White, MD, FSCAI (Nominations Chair and Past President)
- J. Jeffrey Marshall, MD, FSCAI (Nominations Co-chair and Immediate Past President)
- Ted A. Bass, MD, FSCAI (President)
- Tyrone Collins, MD, FSCAI (at-large Nominating Committee member, May 2013 – May 2016)
- Ashok Seth, MD, FSCAI (at-large Nominating Committee member, May 2012 – May 2015)
- Thomas Jones, MD, FSCAI (at-large Nominating Committee member, May 2011– May 2014)
COMMITMENT: The BOT meets in person a minimum of three times a year; the Executive Committee meets twice monthly by conference call. Members of the BOT and Executive Committee are expected to attend all such meetings. Other communications (conference calls, list serve, etc) and meetings are scheduled as events warrant.
ELIGIBILITY: Any Fellow (FSCAI) in good standing may be nominated to serve. If you would like to nominate someone, simply send an email with the person's name and your name to SCAI Executive Director Norm Linsky at email@example.com and to Nominations Chair Dr. Christopher White (firstname.lastname@example.org). All nominations must be received by Friday, February 7, 2014. Thank you!
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