1. What does the future hold for interventional cardiology?
Spencer B. King, III, M.D., M.A.C.C.
St Joseph’s Heart and Vascular Institute
Professor of Medicine, Emeritus
Emory University
CRT 2/6/2012

2. Spencer B. King, MD Honoraria: Celonova Biosciences nContact Surgical
Consulting Fees:
Network for Continuing Medical Education

3. What got us to where we are? What are the issues going forward?
Technology
Evidence / Guidelines
Appropriateness
Reimbursement
Credentialing

5. What got us to where we are?
Catheterization & coronary angiography
Co-axial catheter vessel lumen expansion
Balloon angioplasty
Steerable wires
Stents
Plugs
Valves

6. What got us to where we are? What are the issues going forward?
Technology
Evidence / Guidelines
Appropriateness
Reimbursement
Credentialing

7. Technology Stents are a commodity Wires have arrived
CTO efforts continue to evolve (a little)
Plugs will become differentiated
Valves are perhaps not in their infancy but at least their adolescence
Guidance systems will become more sophisticated

8. Percutaneous Aortic Valve – Current Technique
During position of the PHV, we rapidly pace the right ventricle at rates of beats per minutes. This causes a sudden and predictable drop in cardiac out put as shown in the aortic pressure tracing. When the cardiac output is this depressed, the stent valve can be positioned without potential ejection by the left ventricle. Once the stimulation is stopped, aortic pressure quickly returns. We never stimulate more than a few seconds and we have never had a problem with subsequent ventricular arrhythmias. 8

9. Technology (cont.) New applications for interventional techniques
Structural heart disease
Hypertension
CHF
Angiogenesis & Myogenesis
Diagnostics

10. What got us to where we are? What are the issues going forward?
Technology
Evidence / Guidelines
Appropriateness
Reimbursement
Credentialing

12. Evidence / Guidelines Online Updating Increasing awareness & adherence
Trials sponsored by payers to address issues not interesting to industry

13. What got us to where we are? What are the issues going forward?
Technology
Evidence / Guidelines
Appropriateness
Reimbursement
Credentialing

14. Method of Revascularization of Advanced Coronary Artery Disease
Patel, M. R. et al. J Am Coll Cardiol 2009;53:
Copyright ©2009 American College of Cardiology Foundation. Restrictions may apply.

15. Appropriateness Useful but evolving tools
Main Benefit: Expanding quality improvements efforts
Main Risk: Used to deny reimbursement (This will happen)
Look for a paper by Marso and an editorial by Blankenship in JACC:Interventions February issue.

16. What got us to where we are? What are the issues going forward?
Technology
Evidence / Guidelines
Appropriateness
Reimbursement
Credentialing

18. Reimbursement Not going up! Bundled reimbursement – ACO’s coming
Favors “Heart Team” approach
My best source is the Jack Lewin Blog

19. What got us to where we are? What are the issues going forward?
Technology
Evidence / Guidelines
Appropriateness
Reimbursement
Credentialing

20. Credentialing Certification is the job of ABMS
Credentialing is local and will need to address local circumstances
General Principles
Experience and current activity count
– vs –
Coverage for STEMI call requires bodies
Competition forces reduced requirements
Consolidation enables more restrictive requirements

21. Conclusion The future of interventional cardiology is bright.
Deregulation and a leveling off of coronary interventions bring into question how many interventionalists are needed and what skills are needed.
Consolidation produces the opportunity to improve quality and reduce costs
THIS WILL BE YOUR JOB!