Cath Lab Digest - December 2007 - (Page 17) DECEMBER 2007 SPOTLIGHT 17 continued from page 1 DRUG-ELUTING STENT SOLUTIONS Eisenhower Medical Center Our cath lab team consists of the following: five RNs, four RT(R)s, one cardiovascular technologist (CVT)/ Registered Cardiovascular Invasive Specialist (RCIS), two clerical/support staff, and one cath lab director. We are under the direction of an administrative and a medical director of the cardiac cath lab. The majority of team members have been working together for over ten years, although one of our registered nurses (RNs), Sue Salimaki, is new to the cath lab environment. At the time of this article’s publication, a new cath lab director, Cindy Olson, RN, will also have joined our team, bringing previous managerial experience. Individually, each staff member has twenty-plus years of experience in his/her specialty. This wealth of experience culminates into a dynamic team and a level of performance excellence that exemplifies what Eisenhower Medical Center is all about. What types of procedures are performed at your facility? Our cath lab performs diagnostic and interventional procedures for coronary and peripheral arteries. Electrophysiology procedures (EP) and pacemakers are performed in a separate department due to the large volumes of these procedures. From the last fiscal year (July 1, 2006 to June 30, 2007), our total number of billed procedures was 3,815. Of that, 561 were peripheral angiograms. What type of peripheral interventions are done at your lab? According to cath lab medical director Dr. Barry Hackshaw, the cardiologist group at Eisenhower was among the first in the state of California to apply for and receive peripheral privileges in the cath lab setting. In our cath lab, we currently perform peripheral interventions of the lower extremities and renal arteries only. We utilize current technologies and equipment for peripheral interventions. Our digital imaging capabilities are outstanding, with the use of the bolus chase functions for runoffs. Real-World Registry Data at TCT 2007 This monthly column in Cath Lab Digest reviews important points of distinction in drug-eluting stents (DES), from characteristics to techniques, so that physicians have valuable and relevant information about this revolutionary technology. By John Lasala, MD, PhD, FACC, FACP Professor , of Medicine, Washington University School of Medicine; Director of Interventional Cardiology and Medical Director of the Cardiac Catheterization Lab, Barnes-Jewish Hospital, St. Louis, Missouri. Dr. Lasala received the Outstanding Cardiology Alumnus Award from Yale University School of Medicine in 2000, where he did his cardiology and interventional cardiology fellowships. Currently, Dr. Lasala is Professor of Medicine, Washington University School of Medicine; Director of Interventional Cardiology and Medical Director of the Cardiac Catheterization Lab, Barnes-Jewish Hospital, St. Louis, Missouri. Dr. Lasala is the Primary Investigator for more than 30 research trials and the Co-Investigator for 13 studies, including ARRIVE. He has had more than 40 peer-reviewed manuscripts published and has various editorial responsibilities, including the American Heart Journal, American Journal of Cardiology, Journal of American College of Cardiology, Circulation and Catheterization & Cardiovascular Intervention. Special research interests include congenital heart disease and Stereotaxis. Q A What was your impression of this year’s Transcatheter Cardiovascular Therapeutics (TCT) meeting? The overall atmosphere at TCT 2007 was much calmer than last year’s meeting, buoyed by late follow-up analyses from the major trials and a wide range of stent registry reports. We saw more abundant data — single-center and multi-center studies, as well as regional studies from different geographic areas — so this year we had a much clearer picture of the current state of drug-eluting stents (DES), and there was less concern about some of the previously reported adverse event rates. In a TCT 2007 presentation summarizing all of the trial and registry data to date, Dr. Gregg Stone (Columbia University) concluded that the bulk of the data are largely reassuring. Would you agree? Yes, I would agree with Dr. Stone’s conclusion. The increasing number of cases included in large meta-analyses eliminates some of the sporadic, somewhat spurious, adverse events that the data alluded to earlier. What we see in standard practice when used within labeled indications are rates of mortality and myocardial infarction (MI) with DES being equal to (see Figure 1) — and in some cases even slightly lower than — rates with bare-metal stents (BMS). It is important to remember that with low-frequency events such as very-late stent thrombosis, it is possible for rates to fluctuate quite dramatically. We have to base our conclusions on a much larger number of cases in a broader range of conditions. continued on next page Q A Dr. Padilla, cardiologist, Kathy Stevens, RN, Lynn Hart, RN, Administrative Director. Left to right: Dixie Sargent, RCIS, Bruce Freiman, RT, Steve Jones, RT, Sue Salimaki, RN, Monica Turner, secretary, Kathy Stevens, RN, Mary Jacobs, RN, Mike McKeever, RT.
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