CLI Perspectives

Trailblazing the Path Towards High Quality Care and Improved Cardiovascular Outcomes: Welcome to SCAI 2016!

CLI Perspectives is headed by section editor J.A. Mustapha, MD, Metro Health Hospital, Wyoming, Michigan. 

This month, Dr. Mustapha interviews Society for Cardiovascular Angiography and Interventions (SCAI) President Elect Kenneth Rosenfield, MD, MHCDS, Section Chief Vascular Medicine & Intervention, Institute for Heart, Vascular & Stroke Care, Massachusetts General Hospital, Boston, Massachusetts.

CLI Perspectives is headed by section editor J.A. Mustapha, MD, Metro Health Hospital, Wyoming, Michigan. 

This month, Dr. Mustapha interviews Society for Cardiovascular Angiography and Interventions (SCAI) President Elect Kenneth Rosenfield, MD, MHCDS, Section Chief Vascular Medicine & Intervention, Institute for Heart, Vascular & Stroke Care, Massachusetts General Hospital, Boston, Massachusetts.

The annual meeting of the Society for Cardiac Angiography and Interventions (SCAI) brings together a distinguished group of individuals who are thought leaders in the different fields that inform the current community of interventional cardiologists. From the early days of balloon angioplasty and coronary stents, interventional cardiologists have embarked into different areas of the anatomy in an attempt to provide solutions to the numerous problems our patients face. As such, the Society and the annual SCAI meeting have evolved simultaneously to feature tracks on complex congenital heart disease, structural and valvular interventions, peripheral interventions, and critical limb ischemia. The most recent addition is the quality improvement track. These features have created a unique meeting where interventionalists can learn the latest techniques, devices, and data, as well as how to incorporate this massive flow of information into their practices, while at the same time, complying with ever-changing rules and regulations. It is an honor to interview the Society’s President Elect, Kenneth Rosenfield, MD, MHCDS, who is the Section Chief of Vascular Medicine & Intervention in the Institute for Heart, Vascular & Stroke Care at the Massachusetts General Hospital in Boston.

J.A. Mustapha, MD: SCAI has been traditionally known as a meeting with an emphasis on coronary interventions; however, the program features different tracks.

Kenneth Rosenfield, MD: As you described in the introduction, our meeting has not been stagnant. On the contrary, we take pride on our “chameleon” approach. We are continuously evolving and adapting to the changes that take place in the real world. Since 2012, we adopted the track model with coronary, peripheral, structural, and congenital tracks. That same year was the first time we ever held a Critical Limb Ischemia Symposium. Then, in 2013, we added the quality track. The same year, a CLI session was included as part of the peripheral track.

Dr. Mustapha: Why should cardiologists and cath lab personnel attend SCAI? 

Dr. Rosenfield: There are several features that are unique to the SCAI annual session. At SCAI, we have set our focus on the quality improvement track, covering all aspects of certification and operations. As innovation and disruption continue to be incorporated into our daily lives in the cath lab, the concept of teamwork has become one of the cornerstones driving our efforts towards excellence. This year’s meeting emphasizes the role of the heart team, welcoming nurses, technologists, radiologic technologists, technicians, physician assistants, nurse practitioners, and administrators, and by popular demand, we also expanded the Cath Lab Leadership Bootcamp. 

Dr. Mustapha: How is the SCAI meeting helpful for interventional fellows?

Dr. Rosenfield: I would say this meeting is a “MUST” for all cardiology fellows. General cardiology fellows will have the opportunity to learn the most important interventional aspects of the field, as well as the latest data. Interventional fellows (be it coronary, peripheral, or structural) will have the opportunity to interact on a one-on-one basis with our prestigious faculty and network throughout the meeting while learning about state-of-the-art techniques and devices. Different from other specialty organizations, SCAI favors the incorporation of its members from the earliest stages of their careers. Most of our committees are open and allow the new members to integrate themselves, fostering their cooperation in shaping the future of the Society. In 2010, we created the Emerging Leader Mentorship program, which has been met with incredible success and has produced so far 3 classes conformed of the future leaders in the field. 

Dr. Mustapha: You are one of the national co-principal investigators of the highly anticipated Best-CLI trial. What can you tell us about this landmark study?

Dr. Rosenfield: Best-CLI is a National Institutes of Health (NIH)-funded prospective, multicenter, randomized trial, which seeks to compare “best endovascular” versus “best surgical” approaches to treat patients with CLI. Although “endovascular-first” strategies have gained popularity, the available CLI population data are largely limited to nonrandomized studies focused on a single device and one randomized trial that did not include many of the most commonly used therapies. As Medicare and insurance providers seek to ensure that resources are maximally cost effective, comparative effectiveness data are increasingly sought after. In an attempt to represent the modern clinical scenario as closely as possible, patients randomized to BEST-CLI’s endovascular arm can be treated using nearly any commercially available device and approach according to the preference of the enrolling investigator. Similarly, physicians treating patients enrolled in the open surgical arm can employ the surgical bypass technique or any type of conduit of their choosing. In order to mitigate the possibility that the trial could become dated before it is even complete due to the emergence of newly approved therapies in the upcoming years, therapies not currently in the trial will be reviewed and evaluated for suitability for inclusion as they emerge.

The primary endpoint is major adverse limb event-free survival (above-ankle amputation and major reinterventions). Secondary endpoints include evaluation of minor reinterventions, hemodynamic success, and clinical success. In addition to the cost-effectiveness component, patients will be assessed for functional status and quality of life. 

Dr. J.A. Mustapha can be contacted at jihad.mustapha@metrogr.org.

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