The 2019–20 president of the Society for Cardiovascular Angiography and Interventions (SCAI) Ehtisham Mahmud (division chief, Cardiovascular Medicine, UC San Diego, San Diego, USA) tells Cardiovascular News about his career highlights, and outlines the key priorities for his presidency.
1. Why did you decide to become a doctor, and why did you choose to specialise in interventional cardiology?
I decided to become a doctor when I was 12 years old. At the time, I recognised that I wanted to fix things and help people, and also get paid for it. Later, I particularly appreciated the autonomy of the profession and the ability to impact individual patient lives. As I progressed through medical training, I realised that cardiology—and subsequently interventional cardiology—are specialties where the positive outcomes are immediate and impactful. Additionally, the innovative research and dynamic changes within interventional cardiology made it particularly appealing.
2. Who were the biggest influences on your early career?>
I have been fortunate to be positively influenced and guided by different individuals at various phases of my career. My father, Mahmud Roshan, was instrumental in my choosing to become an academic physician. His passion for his own field—public health—inspired me, as did the intriguing questions he posed at the dinner table. Later, when I was an internal medicine resident and cardiology fellow, the chief of cardiology at UCSD was Tony DeMaria; he was undoubtedly the person who most influenced my decision to become a cardiologist. He has been a lifelong professional mentor and continues to be a source of support and inspiration. Finally, I had the good fortune to train at Emory University with Spencer King and John Douglas, who taught me the skills of an interventionist, and gave me the guidance to be successful in the field.
3. What has been the most important development in interventional cardiology during your career?
During the first decade of my professional career, addressing coronary restenosis was critical, because percutaneous coronary intervention (PCI) was considered an inferior option to bypass surgery. The development of drug eluting stents significantly lowered the rates of coronary restenosis. This helped the field develop to its current state, with PCI becoming the standard for acute myocardial infarction, and now being increasingly used for very complex coronary disease.
During the past decade, the most notable advance has been the percutaneous treatment of structural heart disease. Transcutaneous aortic valve repair, percutaneous mitral valve therapy, and septal defect closure are helping to reduce morbidity and mortality for cardiovascular disease in patients who often have limited surgical options, or no options at all.
4. What has been the greatest disappointment—an advance that you hoped would change practice but has failed to do so?
The failure of bioresorbable coronary scaffolds was definitely disappointing, as expectations were extremely high. We had hoped that, with rapidly advancing medical therapies, the mechanical treatment of coronary disease could be replaced by a bioresorbable scaffold so that an individual patient could have repeat percutaneous interventions or new conduits for bypass grafting. At present, late and very-late scaffold thromboses have limited the development of this technology.
5. What are your current research interests?
My research interests are varied but can be broadly categorised as being translational in nature. Presently, I am focused on investigating new interventional device therapies for primary and secondary pulmonary hypertension, robotic coronary and peripheral interventions, complex PCI, structural therapies for advanced heart failure, and preclinical studies focused on regenerative approaches for the treatment of critical limb ischemia.
6. What do you consider to be your biggest contribution to the field of interventional cardiology?
I believe one of my biggest contributions is in robotic angioplasty. I performed some of the earliest procedures in complex coronary and peripheral vascular disease, and designed and performed the studies that showed its safety and efficacy in complex coronary artery disease (CORA-PCI study). I also designed the studies leading to US Food and Drug Administration (FDA) approval of the technology for peripheral vascular indications (RAPID I and RAPID II studies).
Another significant contribution is the introduction of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) in the USA. I have helped develop optimal and standardised techniques for the procedure, and demonstrated its safety, feasibility, and efficacy in the highest-risk patients, including inoperable CTEPH patients and those with chronic thromboembolic pulmonary disease without pulmonary hypertension.
7. What is the most important paper that was published in the past year?
I think that the COAPT trial published in the New England Journal of Medicine is one of the most important and impactful studies for the practice of interventional cardiology. This was a very well designed multicentre trial which demonstrated that percutaneous mitral valve repair improves quality of life and lowers mortality for patients with functional mitral regurgitation and congestive heart failure.
8. You have just assumed the office of president of the Society for Cardiovascular Angiography and Interventions (SCAI) for 2019–20. What do you intend to focus upon during your term?
Over the next year, I am committed to advancing our work in three areas—enhancing and developing our education platform, growing our international footprint, and fostering the development of the next generation of interventional cardiologists. I intend to provide leadership to international coalitions to raise the standard of interventional practice around the world, particularly in developing countries. In order to achieve that goal, we have just appointed six SCAI ambassadors to China, India, Turkey, Egypt, Vietnam, and Saudi Arabia. I am also committed to supporting the development of the next generation of interventional cardiologists. We will continue to support the SCAI Early Leaders Mentorship Programme, are appointing younger faculty in our scientific programmes, and are providing greater opportunities for our members to serve on committees and councils.
9. How will you build upon the educational initiatives offered by SCAI?
SCAI’s educational initiatives are wide ranging and continue to expand, and include in-person annual scientific sessions, a Fall Fellows course for trainees, and our journal Catheterization and Cardiovascular Interventions. I intend to expand our digital learning platform with an online interactive web portal for practising interventional cardiologists and fellows-in-training. The development of our educational content will be offered as a comprehensive digital learning experience, reaching clinicians wherever they are in the world. We will also collaborate and partner with other Societies and organisations to offer training and education in interventional cardiology.
10. What should be the key priorities for future research in interventional cardiology?
Some of the most salient research priorities for interventional cardiology are within the areas of complex PCI—for example, demonstrating the value of complete percutaneous revascularisation in patients with left ventricular dysfunction, and generating data supporting chronic total occlusion (CTO) revascularisation. We need to identify strategies and improve therapies to address cardiogenic shock and out-of-hospital cardiac arrest. Additionally, the treatment of triscuspid valve disease and right heart failure requires attention.
11. What do you think the next breakthrough innovation in interventional cardiology will be?
In the short term, creating pathways of care could have a dramatic impact on reducing mortality for both cardiogenic shock and out-of-hospital cardiac arrest, both of which have extremely poor outcomes. In the longer term, therapeutic interventional devices for heart failure and regenerative medicine with direct intramyocardial injection and the use of gene- or cell-based therapies has the potential to improve cardiac function and address the epidemic of advanced congestive heart failure and chronic angina.
12. What is the value in this online age of attending conferences?
The SCAI Scientific Sessions is the premier in-person educational conference for interventional cardiologists. Although online portals and messaging can disperse important news quickly and effectively, the value of in-person discussions and sharing of ideas should not be underestimated. In addition, these meetings provide an opportunity to meet and exchange views with interventionists who might not be accessible through the web.
13. Do you use social media and, if so, what is its added value for interventional cardiologists?
Social media is a great way to keep up with what is going on within the interventional world. Check out @SCAI_Prez on Twitter.
14. What advice would you give to someone who was starting out in cardiovascular medicine?
I encourage all new physicians to get involved in leadership so that the future of cardiology is determined by the members of our field. SCAI provides many opportunities for new members to be leaders and get involved in the development of interventional cardiology. Get involved in your medical community at the local, regional, and national level with the intention of making a difference. Challenge current dogma and ensure that you are always exposed to new ideas. Be open to change—that is the currency of success in our time.
15. What was your childhood dream job?
As a child, I wanted to be an fighter pilot. Although, as I indicated earlier, I wanted to be a doctor from the age of 12.
16. What are your hobbies and interests outside medicine?
Outside medicine, I love to travel and spend time on outdoor activities. As a family, we take time to ski during the winter and go hiking in the summer. I have spent time hiking and trekking in the Canadian and American Rockies, the Swiss and Italian Alps, and in northern Pakistan and Southern California. It has been a great way to see the world and bond with my family. I have travelled to more than 30 countries, and I am fascinated to see that, despite differences in customs and cultures, there are similarities in our common humanity.
Current appointments at UC San Diego (selected)
Jul 2017–present: Edith and William M. Perlman Chair of Cardiology
Jul 2017-present: Vice-Chair, Department of Medicine
Jan 2015–present: Executive Governing Board, UC San Diego Health System
Jun 2013–present: Executive Director, Sulpizio Family Cardiovascular Center-Medicine
Aug 2011–present: Division Chief, Cardiovascular Medicine
7/10–present: Professor of Medicine, Department of Medicine
7/05–present: Director, Interventional Cardiovascular Fellowship Programme
7/02–present: Director, John Ross Cardiac Catheterization Laboratory
Postgraduate training and education
1999–2000: Fellowship in coronary and peripheral vascular intervention, Andreas Gruentzig Cardiovascular Center, Emory University, Atlanta, Georgia
1996–99: Fellowship in cardiovascular medicine, UC San Diego
1995–96: Chief resident, Department of Medicine, UC San Diego
1992–95: Internal medicine internship and residency, UC San Diego
1989–90: Rotating internship, University of Alberta, Edmonton, Canada
1985–89: Doctorate of Medicine (MD), University of Alberta, Edmonton, Canada
1983–85: BSc (Medical Science), University of Alberta, Edmonton, Canada
Honours and awards (selected)
2009–2013, 2017–2019: “Top doctors” in cardiovascular disease and interventional cardiology, one of San Diego’s physicians of exceptional excellence, by the San Diego County Medical Society
2018–present: Deputy Editor, Coronary Artery Disease
2017–present: Associate Editor, Structural Heart: The Journal of the Heart Team
2012–14: Associate Editor, Journal of the American College of Cardiology 2017: Bishop’s Lecture, Division of Cardiology, Baylor College of Medicine, Houston, Texas
2016: “Top three abstracts” presented at SCAI Annual Scientific Sessions
2012: “Faculty teaching award”, Division of Cardiovascular Medicine, UC San Diego
2011–19: “America’s top doctors” in interventional cardiology by Castle Connolly Medical Ltd
2003–11: America’s Top Physicians in Interventional Cardiology, by the Consumers’ Research Council of America
2003 Schulman Research Award for Outstanding Cardiovascular Research, UC San Diego