Public Release: 

SCAI'S Hildner Lecture traces progress through 30 years of interventional cardiology

Creative thinking and hard-nosed testing yield remarkable accomplishments

Society for Cardiovascular Angiography and Interventions

(May 11, 2007--ORLANDO, FL) -- The world of interventional cardiology has changed dramatically in nearly three decades, and Donald Baim, M.D., FSCAI, has seen it all. In a keynote Hildner Lecture, to be delivered at the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions, May 9-12, 2007, in Orlando, FL, Dr. Baim will examine major breakthroughs, short-lived disappointments, and future developments in interventional cardiology, all from the vantage point of a career that has spanned 27 years.

"Looking back, I'm struck that we as interventional cardiologists have never simply accepted the limitations placed before us," said Dr. Baim, "We've always tried to overcome them through creative thinking--and then to subject the results of that creativity to the crucible of evidence-based medicine, knowing that sometimes we'll win, and sometime we'll lose, but, always, we'll move forward."

Dr. Baim began his career in interventional cardiology in 1980 at Stanford University, shortly after the birth of interventional cardiology. During 25 years at Harvard University he became an internationally respected educator and renowned innovator in device development. Since July 2006 he has been executive vice president and chief medical and scientific officer for device manufacturer Boston Scientific.

The changes he has observed--and driven forward--are nothing short of remarkable. In the early days of interventional cardiology, for example, catheters were bulky and difficult to maneuver. As a result, only 5-10 percent of patients were candidates for balloon angioplasty, the procedure was successful just 65 percent of the time, and 10 percent of patients experienced a serious complication, including the need for emergency bypass surgery in more than half. Today, approximately two-thirds of patients with diseased coronary arteries are candidates for angioplasty, stenting, and other forms of percutaneous coronary intervention (PCI). The procedure is successful in 98 percent of patients, with a rate of major complications of only 1.5 percent. Just 1 patient in 1,000 needs emergency bypass surgery.

Indeed, nearly 30 years after the first balloon inflation in a human coronary artery, interventional cardiology is enjoying unprecedented success, not only in bread-and-butter coronary interventions, but in advanced new catheter procedures once unimaginable to all but the most innovative thinkers.

The path to success has not always been smooth, however. For example, it was once thought that atherectomy would play an important role in treating restenosis by slicing away, boring through, or evaporating with a laser the overgrowth of scar tissue that can renarrow a coronary artery within months of angioplasty. Instead, stents--which were safer, easier to use, and more effective--came out ahead, and were soon being implanted in nearly every patient who had PCI.

Stents, however, had their own weakness, namely, in-stent restenosis. For a time it was hoped that radiation therapy inside the coronary artery would be the answer. Instead, drug-eluting stents held the day, and as a result, six-month restenosis rates have fallen from approximately 40 percent in the early days of PCI to just 5-7 percent today.

Recently, drug-eluting stents have been found to pose a small but definite increase in the risk of blood clotting in the stent, even long after PCI. Interventional cardiologists are hard at work investigating the causes and solutions to the problem of late stent thrombosis.

"One fundamental message is that over the last 30 years, there have been progressive improvements in the success, safety, and durability of PCI as new technologies have been launched," Dr. Baim said. "But as each innovation solved a serious prior problem, it sometimes introduced a rare new adverse event that needed its own solution."

The corollary to that message is that interventional cardiology never stands still. It is a profession that reinvents itself over and over at an increasing pace, as new devices are developed and new techniques perfected. "This field has evolved progressively and dramatically over the last 30 years, through iterative problem solving and evidence-based medicine," Dr. Baim said. "It is likely to evolve that much or more over the next 10, 20, or 30 years."

Today interventional cardiologists treat diseased arteries not just in the heart, but from top to toe, including the carotid arteries that supply blood to the brain, the renal arteries that supply blood to the kidneys, and the network of vessels throughout the legs and feet.

Interventional cardiologists are also beginning to offer new treatment options to patients with valvular heart disease, replacing diseased aortic valves and repairing leaky mitral valves by threading a catheter into the heart. They are repairing holes in the walls that divide the right and left sides of the heart with catheter-mounted "patches." They are investigating new ways to identify and treat inflamed plaques in the coronary arteries with an eye to preventing heart attacks.

"The progress is not over. It's continuing every day, and interventional cardiologists need to stay plugged into this evolution and participate in it," Dr. Baim said. "No one can afford to be a fly in amber at any point in this evolution."

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About SCAI

Headquartered in Washington, DC, the Society for Cardiovascular Angiography and Interventions is a 3,700-member professional organization representing invasive and interventional cardiologists in 70 nations. SCAI's mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, and advancement of quality standards to enhance patient care. SCAI's annual meeting has become the leading venue for education, discussion, and debate about the latest developments in this dynamic medical specialty.

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