Run-Lin Gao, professor of Medicine, Fu Wai Cardiovascular Hospital, Beijing, China, and chairman of China Interventional Therapeutics (CIT), received this year’s EuroPCR Ethica Award. He was the first to perform emergency PTCA for acute myocardial infarction and the first to report coronary stenting and the use of drug-eluting stents in China. He has received nine academic awards, has over 76 publications in English language journals, has more than 209 original publications and 19 editorials/reviews in peer-reviewed Chinese journals. In this interview with Cardiovascular News, Gao spoke about the Ethica Award, interventional cardiology in China, and the 10th CIT conference, taking place in Beijing in March 2012.
How was receiving the EuroPCR Ethica Award 2011?
It was truly the greatest honour in my life to receive the Ethica Award 2011 from the Board of EuroPCR. I would like to express my sincere thanks for this recognition. I felt too humble to be awarded. I only accomplished an ordinary work in cardiology practice. If I had some achievements in my career in interventional cardiology, the honour does not belong only to me but also to my motherland. Without the rapid development of my country’s economy, interventional cardiology would not have developed so rapidly. The honour also belongs to my mentors, Dr Francis Lau from Loma Linda University Medical School, USA, Dr Shouqi Tao and Dr Zaijia Chen from my hospital, whose mentorship gave me solid foundation for further development. It also belongs to my institution, which provided excellent platform for my clinical and research work; and to my colleagues from my hospital, my country and the world. I want to express my sincere appreciation to all colleagues and friends who have given me great and persistent support and advice in my career.
You have been described as “the father of interventional cardiology in China”. How has practice evolved in China since you started your career?
At TCT 2007, during the opening of a live case transmission from Fu Wai Hospital, Beijing, Dr Martin Leon introduced me “as the father of interventional cardiology in China”. I could not accept this honour; I only see myself as one of the pioneers in interventional cardiology in China. I performed the first case of percutaneous transluminal coronary angioplasty (PTCA) in Fu Wai Hospital in 1986, soon after I had completed my fellowship training under the tutorship of Dr Francis Lau and had come back to China. In 1989, I was the first person to perform emergency PTCA for acute myocardial infarction (AMI) and AMI-complicating cardiogenic shock in China. Also, I was able to be the first to report coronary stenting, intravascular brachytherapy and drug-eluting stent (DES) use in China.
I have tried my best to promote education, training and dissemination of the use of percutaneous coronary intervention (PCI) in China over 20 years. In late 80s and 90s, I went to more than 20 provinces or cities to train local cardiologists to perform PCI procedures, and to organise different symposia or seminars to exchange knowledge and experiences. After 2000, I devoted myself to optimise PCI procedures, to draw up Chinese guidelines, and to assist the China Ministry of Health to formulate personal and technical standards for PCI entry certification system. I have organised the China Interventional Therapeutics (CIT) from 2004. With the strong support from TCT, EuroPCR and other associations and affiliations, CIT has become one of the largest and most educational interventional cardiology meetings in the Asian-Pacific region. Also, I was involved in developing the first Chinese manufactured drug-eluting stent (Firebird) and four other new biodegradable coating DES by leading experimental and clinical studies. Firebird, which was good quality and had a low price, played an important role in the rapid widespread use of DES and development of interventional cardiology in China.
How has PCI grown in China since its introduction in 1985?
Since the introduction of PTCA into China in 1985, with a first report in 1986, there has been exponential growth in annual numbers of PCIs (Figure 1). The expansion and technical evolution of interventional cardiology in China can be roughly divided into three phases. During the first phase, spanning 1985–1996, PCI could only be performed in a few centres by a few cardiologists. According to a national survey, by the Chinese Society of Cardiology, a total of only 6,213 PCI cases had been performed by the end of 1996 in 51 hospitals nationwide with a success rate of 91.9%. Coronary stenting was introduced in 1992 and first reported in 1994.
By 1996, coronary stents had been implanted in 51.3% of patients undergoing PCI in China. The second phase, 1997–2001, saw a rapid growth of PCI in China with a 40% yearly increment in the number of cases. For instance, in 2001, 16,345 PCI cases were performed in 112 hospitals with a success rate of 97% — this number of cases was larger than the combined figures for the previous 15 years. During this time period, stents were implanted in more than 80% of PCI patients. During the third phase, from 2002 until now, the numbers continued to increase. In 2010, more than 290,000 cases were performed in 870 hospitals among 30 provinces.
How are drug-eluting stents being used in China at the moment?
The Cypher stent was introduced in China in 2001. Since then DES penetration rates has rapidly increased. There was a small decrease in the number of DES implanted after WCC, ESC 2006. However, this only lasted for a short period of time. At the moment, the penetration rates of DES are around 90–95% in most of hospitals. Domestically manufactured DES such as Firebird 2, Excel and Partner accounted for 60–70% of all DES used. Imported DES, such as Xience V, Resolute, Cypher, Taxus, etc. accounted for the rest.
What about transcatheter aortic valve implantation (TAVI)?
TAVI has just started in a few centres in China. Recently, the CoreValve was implanted in six cases and Edwards was implanted in only two cases. The wide spreading of TAVI technique will be not possible until the devices are approved by Chinese regulatory authority.
What is your opinion on new imaging technologies (eg, OCT)?
Optical coherence tomography (OCT) is an optical imaging modality that uses near-infrared light to create high-resolution images of coronary arteries. It provides up to 10 times greater resolution than ultrasound (10µm compared with 100µm). It can clearly display the morphology and composition of lesions to identify the vulnerable plaque with thin cap and minor rupture, and assists interventional cardiologists to optimally implant stents from stent placement to follow-up care. In my opinion, OCT is a useful tool in cardiac catheterisation laboratory. At Fu Wai Hospital, it is often used for detecting vulnerable plaque in patients with acute coronary syndrome, optimising stent implantation during procedure and observing the endothelial coverage, intima thickness, thrombosis and stent malapposition during follow-up.
You are the chairman of China Interventional Therapeutics 2012, taking place in Beijing next March. What can delegates expect of this symposium?
CIT, in partnership with TCT, will take place in the China National Convention Center (CHCC) Beijing, from 15–18 March 2012. The delegates will have the chance to celebrate the 10th anniversary of CIT with colleagues from all over the world. More than 5,000 delegates, including 600 international delegates, are expected to attend the meeting. The theme of CIT 2012 is “Clinical Practice and Optimization”. During the four-day meeting, 40 live cases will be transmitted from international and domestic centres. The keynote lecture will be presented at the TCT-CIT Plenary Session. Late-breaking trials, challenging cases and around 900 didactic lectures will be presented. PCR and ESC Working Group on Cardiovascular Surgery, CCT, SOLACI, Angioplasty Summit, CRT, AICT, and NCVH will organise joint programmes at CIT 2011.
The meeting venue, CNCC, is China’s largest and the most modern international conference centre with primary location and completed facilities. I cordially invite everybody to Beijing to attend CIT 2012 in partnership with TCT.