When Antonio Colombo, MD, FACC, first entered medical school in 1968, it was with the goal of becoming a psychiatrist. But he found too much "uncertainty" in the specialty. Instead, he was drawn to the science of cardiology, where he has spent the past 40 years contributing to numerous innovations that have shaped the field, including seminal contributions to improve the technique and pharmacology related to coronary stenting.

Colombo will describe his journey and the key lessons he's learned during his keynote, titled, "My Lifetime Journey in Interventional Cardiology and Future Perspectives." He served as director of cardiovascular interventions at San Raffaele Scientific Institute in Milan, Italy, for 22 years and is now the general coordinator of several catheterization laboratories at the GVM Care and Research, the second largest multi-hospital group in Italy.

His most important message? Failure is important. "We learn more from failures when properly analyzed than from success."

He learned that lesson in 1990 when confronted with his first case of stent thrombosis in a patient already receiving heparin, oral anticoagulants and aspirin. Confused and concerned, he wrote to Richard A. Schatz, MD, FACC, co-inventor of the first coronary stent, about the case. The advice he received formed the foundation for his personal philosophy.

Schatz wrote that several things may have contributed to the thrombosis, including the omission of dipyridamole prior to the procedure, inflow obstruction and underdilation of the stent. However, he continued, "this could be a stroke of bad luck. Don't be discouraged by this one setback." And Schatz added, "I am vitally interested in every complication so I can continue to learn from every case."

"That letter from Dr. Schatz has been a fundamental aspect in my work," Colombo says, which is why it is part of his keynote. It instilled in him a willingness to share his problems with people he considers experts and take their suggestions, advice he will pass on during his keynote.

In addition, Schatz' comments about the possible contributors to the patient's clot helped shape Colombo's future research by confirming some of his own hypotheses about anticoagulation.

Key considerations were that heparin or systemic anticoagulation were not the answer; platelets cannot be "tranquilized" only with aspirin; and there was a need for better stent expansion – all areas he has explored during the past 30 years. Indeed, it led to his pioneering work in dual antiplatelet therapy (DAPT) with ticlopidine and aspirin, something that, at the time, received significant criticism.

For instance, when he began espousing DAPT, one cardiovascular surgeon told him that "there is no question that ticlopidine causes malignant bleeding. I will not operate on any patient who is receiving ticlopidine." Others compared DAPT with combining two beta-blockers.

Colombo's keynote will provide key highlights in the development of stents and antiplatelet and anticoagulant therapy to reduce the risk of stent thrombosis. He will also highlight important research needs in the field moving forward, including continuous efforts to improve on DAPT and stent implantation to reduce early acute and subacute thrombosis; and a better understanding of the causes of late and very late stent thrombosis.

Watch the 2020 Simon Dack Keynote at Virtual.ACC.org.

Clinical Topics: Anticoagulation Management, Invasive Cardiovascular Angiography and Intervention, Statins

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Scientific Session Newspaper 2020, ACC Annual Scientific Session, acc20, ACC International, Anticoagulants, Aspirin, Blood Platelets, Catheterization, Dipyridamole, Hemorrhage, Heparin, Inventors, Italy, Longitudinal Studies, Platelet Aggregation Inhibitors, Stents, Stroke, Surgeons, Thrombosis, Ticlopidine, Tranquilizing Agents

< Back to Listings