It is not by muscle, speed or physical dexterity that great things are achieved

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While the Ancient Roman orator and statesman Marcus Tullius Cicero was reflecting on human nature, his sentiment can also be applied to the proper treatment of acute MI patients. Several studies at this year’s Society for Cardiovascular Angiography and Interventions conference in San Diego speak, instead, to the necessity of a systematic department-wide approach for improved care.

Lim et al presented evidence that launching a transradial program at an academic center requires a substantial period of time, but the authors say that the learning curve for their fellows was worth the efforts because of the safety benefits to the patients.

Once a program is implemented, Gilchrist et al found that utilizing a transradial approach can bunk the conventional (and guideline-recommended) idea that PCI patients must stay overnight. “A broad range of patients who have transradial PCI can be discharged the same day if they have had an uneventful procedure without complications,” Gilchrist said.

Another SCAI study, conducted by researchers from Aurora St. Luke’s Medical Center in Milwaukee, found that round-the-clock staffing to treat primary PCI for STEMI patients eliminates longer door-to-balloon times associated with off-hours presentation and reduces mortality in patients who present off hours. However, Jan et al cautioned that type of program requires a “systems change,” and commitment from both physicians and the hospital.

Finally, a presentation yesterday from Dr. Kimberly A. Skelding focused on the diagnosis and treatment disparities for female patients with acute coronary syndrome or acute MI, and how cardiologists across the U.S. need to re-evaluate the practice methods.

These studies provide a guide for improving cardiology practice not through a particular person’s ability, but through system-wide assessment. Only through those means will practices rectify any clinical errors, for as Cicero suggests: Any man can make mistakes, but only an idiot persists in his error.

On these topics, or any others, please feel free to contact me.

Justine Cadet