This past weekend, the Society for Cardiovascular Angiography & Interventions (SCAI) held their second consecutive virtual Scientific Sessions, and it went off better than ever. With more than 8,900 participants, 400 faculty, and 350 abstracts, it highlighted the scientific accomplishments during a difficult year. The departure from the traditional format to a virtual conference had many advantages. The virtual format allowed greater attendance by a broader audience; moreover, the “single channel” approach meant that more presentations could be attended without conflict. In a virtual conference, live cases could be presented from around the world, sharing different local experiences, and highlighting education in its purest form. Case discussions were broad-ranging, including discussion of the not-yet-FDA-approved drug-coated balloons in treating coronary in-stent restenosis, as well as the presentation of an infected coronary aneurysm, which in fact is not as rare in developing countries due to the practice of reusing equipment.
The direct effects of the pandemic were on display throughout the conference. The SCAI team did a fantastic job highlighting the successes of interventional cardiology during the COVID-19 pandemic. Studies showed that there was a 40% reduction of STEMI activations during the pandemic. This was underscored by SCAI President Dr. Cindy Grines, who reviewed a survey showing 60% of Americans were more afraid of COVID-19 than a heart attack or stroke. Additionally, participants were forced to consider the 5,000-plus patients with severe aortic stenosis who did not receive a TAVR last year and contemplate how we, as a society, will work to overcome post pandemic surges. The conference spotlighted the dedication and prompt collaboration between SCAI and ACC in publishing guidelines for patients with both COVID-19 and myocardial infarction in March 2020. The initial findings of the North American COVID-19 Myocardial Registry were published during the conference and confirmed that these guidelines took the correct approach in treating vulnerable patients with COVID-19.
COVID-19 was not the only massive challenge we confronted in the past year. Countless acts of violence and persecution against people of color dominated the news. SCAI’s Hildner Lecture was given by Dr. Quinn Capers IV, who made an impassioned plea for reconciliation of past health care disparities and drew attention to the unsettling fact that these disparities continue to persist. Dr. Capers opened the session with an original piece of artwork done by his young daughter, depicting a black doctor between two forces: a COVID-19 virion to the left and a policeman to his right, with a city burning in the background. Dr. Capers further discussed the history of health care inequality, the contributing factors that allow inequalities to continue, and provided a plan to address these systemic issues and finally achieve equity of care.
One standout late-breaking piece of clinical science discussed the “real-world” of stable ischemic heart disease (SIHD) and the previously published ISCHEMIA trial. Using the National Cardiovascular Data Registry’s CathPCI registry, Dr. Jay Giri found that American patients with SIHD were a minority of those receiving PCI, and that only a small subset of those with SIHD (32.3%) would classically fit the enrollment criteria into the ISCHEMIA trial. This underscores the need for further research in this area, and that the widely publicized ISCHEMIA trial may not provide the definitive answer, nor is the study population representative of the majority of patients being treated for SIHD.
A controversial topic was the use of Ambulatory Surgical Centers (ASC) to perform PCI. SCAI released a position statement last May following CMS reimbursement for PCI, and more recently, the coverage expanded reimbursement for atherectomy, bypass graft interventions, and chronic total occlusions. The document illustrates the evolution of PCI citing success with centers performing PCI without cardiothoracic surgical backup, same-day discharge following PCI, and within the peripheral arterial intervention in ASCs. This led to one of the most thoughtful debates of the conference utilizing both video conferencing and the moderated chat. This certainly is an area of active interest in the community, and addressing safety, quality, and standardization will be a priority for SCAI in coming years.
Overall, it was a staggering amount of high-quality material discussed over four days. The field’s acceleration into the future was demonstrated through the vast array of complex topics and discussions. For instance, discussion of left main and bifurcation PCI, percutaneous tricuspid valve repair and replacement, and discussion of non-invasive coronary physiology demonstrate the rapidity of medical advancement within interventional cardiology. Finally, hearing from cardiologists on the forefront of robotic-PCI regarding the challenges and advancement in the field truly seems to be from science fiction, but may soon become a reality. SCAI’s announcement of the launch of the Journal of The Society for Cardiovascular Angiography & Interventions will provide another platform for medical discussion and innovation. The future is bright, and SCAI is leading the way.
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