Cath Lab Digest - May 2008 - (Page 29)

MAY 2008 SICP: PROFESSIONALS OUT IN FRONT 29 DRUG-ELUTING STENT SOLUTIONS The Ten-Minute Interview with… Christopher Kambak, RT(R) Oregon Heart & Vascular Institute, Sacred Heart Medical Center, Eugene, Oregon each position. Our lab does require that an RT be in the room whenever an exam using fluoro is performed. What is the biggest challenge you see regarding your role in the cardiovascular lab? My biggest challenge is earning the trust of the new doctors. It’s a great feeling on the day they turn to you and ask, “Chris, what do you think we should do here?” and then take your suggestion and do it. What motivates you to continue working in the CV lab? I truly love my job. Patient contact is probably the most important reason. The knowledge that I am part of the solution to a patient’s health problem(s) is a real boost to the daily work. I enjoy putting patients at ease and making their procedure less stressful. The other part of my job I like is my co-workers. They help make my workday a joy. What is the most unusual case you can recall? We had a patient come to the lab that had infarcted 3 or 4 days before. She ruptured her left ventricle while she was on the table. We tried extremely hard to save her. When work gets stressful and you experience low moments (as we all do), what do you do to help keep your morale high? I turn to my co-workers for support. I am usually pretty easygoing, so people can tell fairly quickly when I am bothered by something and never hesitate to ask what is going on. Comparing Drug-Eluting Stents and Bare-Metal Stents This monthly column in Cath Lab Digest reviews important points of distinction in drug-eluting stents, from characteristics to techniques, to provide valuable and relevant information about this technology. Ajay J. Kirtane, MD, SM, Assistant Professor of Clinical Medicine, Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center Ajay J. Kirtane, MD, SM, is a practicing interventional cardiologist at New York Presbyterian Hospital/Columbia University Medical Center. Dr. Kirtane's research interests are in clinical trial methodology and analysis relating to device and pharmacologic studies of cardiac and peripheral interventional procedures. He is a graduate of Princeton University and Columbia University College of Physicians and Surgeons, and completed his residency at the University of California at San Francisco. Dr. Kirtane completed clinical and research fellowships in cardiovascular disease and coronary and peripheral vascular intervention at Beth Israel Deaconess Medical Center and Harvard Medical School. During this time, Dr. Kirtane also received a Masters of Science degree in Clinical Epidemiology from the Harvard School of Public Health. Q Data presented at the 2006 European Society of Cardiology (ESC) meeting suggested that drug-eluting stents (DES) might not be as safe as bare-metal stents (BMS). Now, it appears the tide has changed. Why? Concerns about the safety of DES were initially prompted by data from studies such as the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), the Bern-Rotterdam Registry, and two meta-analyses assessing somewhat unconventional endpoints which suggested DES may cause harm. Since that time, an abundance of data — from both randomized clinical trials and registries — has been published and presented that has been largely reassuring, including a re-analysis of SCAAR using more updated data which observed no increase in mortality with DES. In total, these studies do not suggest an excess of events such as mortality or myocardial infarction (MI) occurring with DES compared to BMS. The SCAAR and Bern-Rotterdam studies additionally brought to light the phenomenon of late-stent thrombosis. While there has been a growing appreciation of the risk of late-stent thrombosis since this time, most studies have shown that the incidence of late-stent thrombosis is relatively low overall. In addition, there are benefits associated with DES when used within their approved indications — particularly in terms of reducing the rate of repeat revascularization procedures — that seem to outweigh the risks, particularly given that repeat revascularization due to restenosis occurs not infrequently with BMS. Q Describe the design and objective of your analysis of DES and BMS presented at this year’s American College of Cardiology (ACC) meeting. We wanted to synthesize the vast amount of data comparing DES and BMS in order to systematically determine whether there was any safety or efficacy signals with either type of stent (DES or BMS). We searched the published and presented literature to identify all DES and BMS outcomes studies. Studies had to include 100 patients or more, and had to report outcomes continuously for one year or more. We identified more than 20 randomized clinical trials (enrolling 9,470 patients) A Why did you choose to work in the invasive cardiology field? I spent approximately 15 years employed in sawmills, working my way from cleanup to foreman before being laid off in September of 1991. One week after the layoff, I was back in school. Five years later, I graduated from Oregon Institute of Technology (OIT) as an x-ray technologist. I spent 2+ years working nights as a diagnostic x-ray tech, mostly in the emergency department. I had been introduced to the cath lab during my training at OIT and was hooked. When a job opened at Oregon Heart & Vascular Institute, I was fortunate enough to get hired. We are privileged to have both interventional radiology and cardiac labs at our hospital, so we split our time between them. Can you describe your role in the cardiovascular lab? Our labs are comprised of RTs, CVT/RCISs and RNs. The RT and CVT/RCIS role is to monitor, scrub and x-ray. We all rotate through A continued on next page It’s a great feeling on the day a physician turns to you and asks, “Chris, what do you think we should do here?” and then takes your suggestion and does it.

Table of Contents Feed for the Digital Edition of Cath Lab Digest - May 2008

Cath Lab Digest - May 2008 The King Faisal Specialist Hospital and Research Centre Cell Therapy in the Cath Lab for Heart Failure: A Look at MyoCell® Therapy and the SEISMIC Trial Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Contents Clinical Editor’s Corner Commentary: Performance Improvement Strategies Speed Up Treatment Times in the Management of ST-Elevation Myocardial Infarction (STEMI) Patients Ask the STEMI Expert Comparing Drug-Eluting Stents and Bare-Metal Stents SICP: The Ten-Minute Interview with… Christopher Kambak, RT(R) Cardiac Cath Lab Economics in a Public Hospital of a Developing Country Keeping Your Heart & Vascular Employees: Proven Ideas for an Effective Retention Plan Unspoken Words Ask the Clinical Instructor Society of Invasive Cardiovascular Professionals Meetings Calendar Education Center What Do You Think? Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - May 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.