C Michael Gibson

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C Michael Gibson (Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical, Harvard Medical School, Boston, USA) receives “instant gratification” from making a patient “feel better” by opening up their artery after a myocardial infarction. However, his current life goal is to “paint more and work less”. He talks to Cardiovascular News about his achievements, including the websites Wikidoc and www.clinicaltrialresults.org

Why did you decide to go into medicine and in particular why interventional cardiology?

I liked science and I liked helping people, so medicine seemed like a natural choice. I also like working with my hands—interventional cardiology allows me to use my visual “athlete/artistic skills” as well as my cognitive skills, making for a very satisfying career. There is also a lot of instant gratification: someone is having a heart attack, you open their artery, and he/she feels better; you have done something that actually may have saved their life! It is a great feeling.

Who have been your career mentors?

Dr Eugene Braunwald has been my career mentor since approximately 1989. His mentorship and the time I have spent with him has been one of the greatest rewards of my career.

The most important lesson he taught me was to pay obsessive attention 
to details.

This year marks the 40th anniversary of the first human coronary angioplasty. What do you think has been the most important development during that time?

Obviously the introduction of the intracoronary stent has been of tremendous importance, but the impact of stenting has been paralleled by the development of the drugs that make stents work better; for example, antiplatelets and antithrombotics.

What has been the biggest disappointment? For example something you thought would change practice but did not?

The biggest disappointments have been aortic balloon angioplasty because it was associated with high rates of reoccurrence and intracoronary rotablation because it was associated with so much downstream embolisation.

What do you hope will be the biggest development in the next 40 years?

My greatest hope is that I will be put out of business! I think that aggressive preventive therapies will get us a long way to preventing events and that many of us will be relegated to the role of just taking care of acute cases where preventive therapy fails.

Of the research you have been involved with, what do you think has had the biggest impact on clinical practice?

I think the developments of antiplatelets and antithrombotics as part of the acute and subacute therapy of patients has been thrilling to be part of. Obviously, I have enjoyed working on preventive strategies as well.

I published five manuscripts in The New England Journal of Medicine last year and several were interesting. The results of the APEX (Acute medically Ill venous thromboembolism pevention with extended duration betrixaban) trial led to the approval of betrixaban, a new factor Xa inhibitor for the treatment of the medically ill. We also published the results regarding andexanet, a drug that will reverse Factor Xa inhibitors. The publication of the results of the PIONEER (Open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention) trial gave practitioners off label choices as to how to manage patients with both a stent and atrial fibrillation.

What are your current research interests?

My current research interests revolve around preventive strategies, such as infusing human good cholesterol or ApoA1 to regress plaque, the evaluation of the new PCSK9 inhibitors and the agents that follow them, and investigating the next generation of antiplatelet/antithrombotic agents. Another overarching interest of ours at this point is machine learning and how artificial intelligence can help inform better decisions not just for populations but for the individual patient care.

You are the founder and chairman of the website Wikidoc. What are the aims and goals of the site?

WikiDoc is meant to facilitate collaborative authoring among a vast number of people in the medical community and is meant to promote wide and freely accessible dissemination of that information. The site is “copyleft” meaning that you are free to take the content and redistribute it freely. I have worked on the site now for 12 years with more than 2,200 volunteers from around the world. The site has been edited about 1.3 million times by all these volunteers and continues to improve. I think it is a testament to what we can all do together when we collaborate and work towards a shared goal.

You also run clinical trial results. What are the aims and goals of the site?

I developed www.clinicaltrialresults.org back in the late 1990s as a site to share PowerPoint slides among cardiologists. Since that time, we have posted thousands of slides from late breaking trials and have conducted more than 2,000 interviews about those trials. The site has become a free repository of much of the late breaking clinical trials data in the cardiovascular space. When you search for a PowerPoint slide related to cardiology trials, you are often brought to the site.

You are an active user of Twitter (@CMichaelGibson). What are the pros and cons of using social media to further medical knowledge?

Obviously, I drill down very deeply into individual silos of knowledge in my research, but I like to use Twitter to keep up on news and to skim information across multiple silos of scientific knowledge.

It is an important part of disseminating scientific knowledge and has been embraced at cardiovascular meetings.

What has been your most memorable case and why?

I will never forget the case of a veteran I took care of who was having an acute myocardial infarction. I opened the right coronary artery but despite that, he had a persistent stain down in the distal myocardial bed. This was not a wire perforation and it was an area where the dye simply could not leave this is part of the myocardium. We could not make the stain go away and this patient unfortunately died from refractory ventricular arrhythmias. It always stuck in my mind and informed what I would later develop and call the myocardial blush grade or thrombolysis in myocardial infarction (TIMI) myocardial perfusion grade. In this system, we assess flow in the muscle and clearance of dye from the muscle rather than flow down the artery which is what we often focus on.

What advice would you give interventional cardiologists who were just starting their careers?

Do not run away from tough cases! Run towards the tough cases! These cases are where you learn the most. Do not just try to do as many cases as you can, but also try to read as many articles as you can to improve your cognitive foundation of knowledge.

What was your childhood dream job?

Didn’t we all want to be a rock star?

Outside of medicine what are your hobbies and interests?

As many people know, I am an accomplished black-and-white fine art photographer and have had my work exhibited in one-man shows of both personal and public collections. I am also a painter. My goal at this point is to paint more and work less!

Current appointments

2012–present: Professor, Harvard Medical School, Boston, USA

2010—present: Consulting professor, Duke Medical School, Durham, USA

2006– Chief of Clinical Research, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, USA

2001–present: Associate physician, Beth Israel Deaconess Medical Center, Boston, USA

1989–present: Founder and chairman: PERFUSE Core Laboratories and Data Coordinating Center, Beth Israel Deaconess Medical Center, Boston, USA

Education

1982: BA, Phi Beta Kapp, Biological Sciences, University of Chicago, Chicago, USA

1984: MS, Arts and Sciences Basic to Human Biology and Medicine, Pritzker School of Medicine, University of Chicago, Chicago, USA

1986: MD, Graduation with Honors, Alpha Omega Alpha Medicine, Pritzker School of Medicine, University of Chicago, Chicago, USA

Professional Societies

  • American College of Angiology (fellow)
  • American College of Cardiology (fellow)
  • American Heart Association (member
  • American Medical Association (member)
  • Cardiovascular Research Technologies (Course direct, ACS + AMI Management, since 2012)
  • Society for Cardiovascular Angiography and Interventions (fellow)
  • Transcatheter Cardiovascular Therapeutics (associate director since 2012)

Key studies

  • The original description of the TIMI frame count and the TIMI myocardial perfusion grade
  • A publication summarising 15 years of efforts to improve door-to-balloon times and the impact on outcomes
  • PIONEER-PCI
  • ATLAS-2 (Rivaroxaban in patients with a recent acute coronary

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