March 28th, 2012
A Great Take-Away Message
Jeremiah Depta, MD
Several Cardiology Fellows who are attending ACC.12 this week are blogging together on CardioExchange. The Fellows include Tariq Ahmad, Bill Cornwell, Megan Coylewright, Jeremiah Depta, and John Ryan (moderator). Read the previous post here.
The 2012 ACC meeting has come to a close. For me, the experience was amazing. The opportunity to learn and interact with friends, co-fellows, junior faculty, and experts in our field was priceless.
Yesterday, I attended the 11th Annual Maseri-Florio International Lecture. The session was chaired by Dr. Gregg Stone, who introduced Dr. Antonio Colombo as the invited lecturer. As a future interventionalist, I was incredibly excited to hear Dr. Colombo, as I have been an avid reader of his research, review articles, and chapters. I was amazed at the number of leaders in cardiology who attended the session.
Hearing Dr. Colombo speak about coronary intervention was enlightening. He started the lecture by showing his first PCI. For someone who has influenced the lives of millions of patients, it was remarkable that he chose to speak about his first experience placing a stent. He then went on to describe his first stent thrombosis, which I believe he said occurred during his third case. At this point, his words echoed an ethereal message. He described how he could not understand why this patient had a stent thrombosis. To paraphrase him, he stated that he could have blamed it on a stroke of bad luck, but that this way of thinking was incorrect. He said you should never accept a bad outcome as a stroke of bad luck. The outliers (i.e. bad outcomes) are the cases where we can learn the most and are an opportunity to advance the field of intervention.
From his experience with his first stent thrombosis, he came up with the idea that in order to prevent stent thrombosis you needed to have appropriate anticoagulation and platelet inhibition, excellent distal blood flow, and an appropriate lumen size post-stenting. These concepts spurred him initially to used dual antiplatelet therapy with aspirin and ticlopidine, when few people were using dual antiplatelet therapy. Dr. Stone recounted being sent to visit him to understand what “this guy” was doing over in Italy. He recalled that he discounted Dr. Colombo’s approach to antiplatelet therapy but admitted that he was obviously correct given the landslide of evidence proving Colombo’s theory. As an innovator, Dr. Colombo has shaped the way in which interventional cardiologists treat simple and complex coronary disease. Adhering to his theories, he helped to pioneer the use of intravascular ultrasound to optimize PCI. He also has revolutionized how we treat complex bifurcation lesions. It was quite an experience to see him philosophize about his approach to patient care, research, and life.
Walking away from his lecture, I took my single most important message from the 2012 ACC — to understand the outliers and to never equate a bad outcome as a stroke of bad luck. Throughout my training, I can recount numerous patients where I didn’t take the steps to understand what went wrong and how it can be fixed. His message of trying to understand the unexplainable is a message that I will carry throughout the remaidner of my career.
It is amazing to me that you can learn so much from just a few words…