American College of Cardiology

April 2005
Vol. 1 No. 4

Approach with Caution

By Frank Zidar, M.D.
In the absence of affecting the ultimate endpoint, which is mortality, many interventional trials use the composite of death, myocardial infarction (MI) or target vessel revascularization (TVR) as an accepted primary endpoint. When significant, this composite is often carried by a decrease in TVR alone, as was the case with TAXUS-IV out to two years.

Angiographic late coronary lumen loss does correlate with clinical events, but it is still a surrogate marker for the more important clinical endpoint. With each degree of separation, we are further away from what matters most to patients, and that is clinical events such as death, MI, or TVR.

Subgroup analyses from large trials, such as the TAXUS IV substudies, are often post-hoc and may be underpowered. However, the studies can be useful in that they generate new hypotheses and identify areas that require more prospective studies. The TAXUS-IV outcomes based on sex and revascularized artery should be viewed in this light. The information may warrant additional investigation but should not alter current practice.

Dr. Zidar is an interventional cardiology fellow with the Interventional Cardiac Cath Lab, Duke University Health System, Durham, N.C. He also serves on the Task Force to Develop Interventional Cardiology Business Plan.

By Leo Polosajian, M.D.
The SIRIUS and the TAXUS IV studies clearly reveal a benefit in morbidity and target vessel revascularization (TVR) for patients receiving Sirolimus stents vs. those receiving bare metal stents. Head-to-head studies of two types of DES (the REALITY and SIRTAX studies), have shown the benefits of Sirolimus stents in decreasing the incidence of Major Adverse Clinical Events (MACE) and Target Lesion Revascularization (TLR) in multicenter, randomized studies.

These studies, along with the ISAR DIABETES, TAXUS IV-Angiographic, and TAXUS V studies, make it clear that DES provide better clinical outcomes than BMS.

However, no matter the type of stent, we cannot forget a certain reality. Educating patients, particularly as to the importance of taking their medications, is one of the most critical issues in ensuring good clinical outcomes after stent placement.

As clinicians, we should concentrate on educating patients about the importance of their medications. It is mandatory that we explain in laymen’s terms the reasons why compliance is crucial.

Education enhances understanding and compliance. In reality, many clinicians do not give patients an opportunity to understand thoroughly the risks and benefits of medications that can optimize their outcomes after stent placement.

Dr. Polosajian is a second-year fellow with the University of Connecticut Health Science Center in Farmington, Conn.

Fellows in Training Newsletter Needs You
If you would like to contribute to Fellows in Training newsletter, please send your feedback, content suggestions or contributions to adees@acc.org.

If you’re thinking about a career in academic cardiovascular medicine, don’t miss “How to Become a Cardiovascular Investigator,” June 3 – 4, 2005, in Bethesda, Md. Valentin Fuster, M.D., Ph.D., F.A.C.C., and Robert O. Bonow, M.D., F.A.C.C., bring together a group of renowned cardiovascular investigators for this long-running and highly successful program.

Find out what you need to establish a successful career in research by attending lectures and workshops on
• Career options in academic cardiovascular medicine
• Ways to obtain independent grant funding
• Ethics and publishing for investigators
• Integrating an academic career with patient care, research and teaching

“The ACC workshop helps participants see if they are suited for a career in academic medicine, and provides them with the necessary tools to compete successfully for peer-reviewed funding from the NIH and other agencies,” commented C. William Balke, M.D., University of Kentucky School of Medicine, this past year.

This program is free to ACC Fellows in Training. Click here for more information.

Additional Education Opportunities

ACCF Study Session for Continuous Professional Development, May 12, 2005, Chicago. Co-directed by Rick A. Nishimura, M.D., F.A.C.C., and Patrick T. O'Gara, M.D., F.A.C.C. Click here for more information.

Cardiovascular Magnetic Resonance and Computed Tomography — State of the Art, June 25 – 28, 2005, Washington, D.C. Directed by W. Gregory Hundley, M.D., F.A.C.C., F.A.H.A., and Christopher M. Kramer, M.D., F.A.C.C., F.A.H.A. Ten travel scholarships are being offered for Fellows in Training. Click here for more information.

ACCF Cardiovascular Board Review for Certification and Recertification, Sept. 7 – 12, 2005, Dallas, Texas. Directed by Kim A. Eagle, M.D., F.A.C.C. and Patrick T. O’Gara, M.D., F.A.C.C. Click here for more information.

Interested in hearing about the “Atherosclerotic Effects of Lipid-Lowering Therapy Measured by Non-invasive MRI” from two of the researchers who conducted the study?

Join Adolph Hutter, M.D., M.A.C.C., and colleagues at http://conversations.acc.org for a fast-paced 20-minute session with Zahi Fayad, Ph.D. and Yukihiko Momiyama, M.D.

“Conversations with Experts” is free to ACC members. Archived sessions include “SYNERGY: Analyzing New Data from this 10,000 Patient Trial” and “Revisiting the COMET Trial.” To access, go to http://conversations.acc.org or www.cardiosource.com and scroll down to the Conversations with Experts button.

If you weren’t able to attend ACC ’05 or you missed a special session while you were there, see it now at http://www.acc05online.acc.org. More than 1,000 ACC ’05 sessions are now available online, free to ACC members and ACC ’05 attendees. The only exceptions are those sessions for which ACC did not receive permission.

CD and DVD versions will be available May 1, 2005. Information on pricing and ordering of subscriptions for nonmembers is available at http://www.acc05online.acc.org.

• New! ACCF/Guidant Foundation Fellowship and Career Development Award in Women's Cardiovascular Health.
• New! ACCF/Merck Research Fellowships in Cardiovascular Disease and the Metabolic Syndrome: 4 one-year fellowships at $65,000.
• Read about 2005 ACCF Research Awardees.
• New this year — All ACCF Research Awards applications are due by October 3, 2005.

We Need Your Responses: Electronic Survey Coming Soon
With the help of the Fellows in Training Committee, staff will be conducting an electronic survey to ask cardiology fellows how their benefits could be improved. Please watch your email for the survey in May. We need to hear from you about your ACC membership experience and what changes or improvements you would like to see.

Do You Know Where to Find What?
ACC staff will be re-organizing acc.org to make navigation easier for our members. Our goal is to give you access to the information you want, as quickly and easily as possible. Look for an updated Web site in the next few months. In the meantime, we hope these links will help you find what you need on our Web site:

• Fellows in Training Home page http://www.acc.org/about/Fellows/index.htm
• FIT Committee
http://www.acc.org/about/Fellows/committee/index.htm
• Benefits of Membership
http://www.acc.org/about/Fellows/benefits.htm
• FIT Links/Activities
http://www.acc.org/about/Fellows/links/index.htm

Since 1994 employers and cardiovascular specialists alike have recognized the ACC’s job bank as the “go-to” recruitment resource. On average more than 1,300 candidates contact prospective employers via the ACC’s job bank annually. The site averages about 600 job openings each month.

With more than 30,000 members, the ACC offers the broadest exposure for employers’ job postings, including the entire ACC Cardiology Careers Community.

Candidates in adult and pediatric cardiology and cardiovascular surgery may
• Search hundreds of quality, cardiology-specific job listings
• Post a CV or résumé, confidentially if desired
• Send a cover letter with a CV or résumé
• Receive e-mail notification of new job postings.

Positions Available

SOUTH
Position Available - Jacksonville, Florida. Excellent opportunity for board-certified, board-eligible clinical cardiologist with nuclear training to join established cardiology practice. Experience in TEE and EP a plus but not required. Excellent compensation package leading to partnership. Contact: Sharon Phillips at 800-659-5507 or send CV to: 6859 Belfort Oaks Place, Jacksonville, FL 32216. Fax: 904-296-0279 January 2005

Position Available - Sarasota, Florida, Immediate Availability for a BC/BE Cardiologist for a busy cardiology department within a 50+ physician MSG located in a thriving Gulf Coast city in beautiful SW Florida. Excellent compensation and benefit package with partnership tract and a great call schedule. For confidential consideration send/fax CV to Administrator, Intercoastal Medical Group, Inc., 943 S. Beneva Road, Suite 306, Sarasota Florida 34232; Fax (941) 952-0132. January 2005

Position Available – Tennessee. Recruiting Invasive/Non-invasive Cardiologist for St. Mary's Health System and East Tennessee Heart Consultants for outlying towns of Jefferson City and LaFollette, Tennessee. The group offers a full array of cardiology procedures. If you are interested in learning more about these opportunities, please contact: Karen McKinney, St. Mary's Health System, 865-545-6529, or kmckinne@stmaryshealth.com. April 2005

Position Available – Knoxville, Tennessee. EP Cardiologist to join stellar seven-member group of F.A.C.C. Cardiologists, part of East Tennessee Heart Consultants, at St. Mary´s Health System with new state-of-the-art EP Lab. Knoxville, home to the University of Tennessee, sits in the foothills of the Great Smoky Mountains. Excellent public and private schools. Competitive salary with partnership track. If you are interested in learning more about these opportunities, please contact: Karen McKinney, St. Mary's Health System, 865-545-6529, or kmckinne@stmaryshealth.com. April 2005

MIDWEST
Position Available—Wichita Clinic, Wichita, Kansas. Exceptional Non-invasive or Invasive/Non-interventional Cardiologist opportunity. Thriving cardiology department with large built-in primary care referral base. Weekend call 1:3. Low managed care, outstanding benefits, shareholder eligibility after one year. Collegial atmosphere and beautiful mid-western location provides attractive home and work environment! Contact Debbie Gleason: Toll Free 800-876-5111 ext. 9415, or 316- 689-9415 or send CV by fax to 316- 689-9710 or E-mail gleasondk@wichitaclinic.com.

Position Available – Ohio. Seeking a motivated cardiologist to join a growing medical community. This opportunity will be shared by two primary hospitals, Mercy Hospital of Tiffin and Mercy Hospital of Willard. Both hospitals are general acute care facilities characterized by their family-centered care, community involvement, and progressive ideas in health care. They have modern facilities, state of the art equipment, highly skilled personnel and a loyal, stable medical staff offering primary care, as well as a wide range of specialist services.

Located in the heart of north central Ohio, Tiffin and Willard are home to a strong industrial base, growing retail businesses and community-oriented residents. Both offer a fair tax structure, excellent child care, strong educational systems and recreational activities. The small town atmosphere blends well with the commercial opportunities, making this area a place where people enjoy living and working. Outdoors lovers will enjoy our close proximity to Lake Erie. Additionally, we are a short driving distance from Cleveland, Columbus and Toledo.

If you are considering hospital-sponsored career opportunities, we would like to speak with you in confidence. Inquiries including curriculum vitae should be addressed to Tom Leeds, Medical Staff Recruiter, Mercy Health Partners, 2200 Jefferson Ave., Toledo, Ohio 43624, or call 1 (800) 837-4664, ext. 3999. April 2005

WEST
Position Available - Bellingham, Washington, We are ready to open our new state-of- art Cardiology Center and want to add 2 General and 1 Nuclear Cardiologist. Our local Hospital just opened a new Cardiovascular Center two years ago. Bellingham is located on Puget Sound between Seattle and Vancouver, BC and is rated by Outside, Money, Kiplinger and National Geographic as one of the most desirable US cities. Visit our website www.madronamedical.com or send CV or inquiry to crthompson@hinet.org January 2005

Position Available - Southern California. Large multispecialty group seeking an interventional or non-interventional cardiologist to join cardiology section of 2 interventional and 1 non-invasive cardiologist. EP or nuclear training a plus. Our progressive practice model offers the best of both an appreciation of personal lifestyle, and a dynamic professional environment. Great starting salary and early partnership option. Mika McIntyre, Caremore Medical Group, Fax 562-662-2818; E mail Mika.Mcintyre@caremore.org January 2005