When a heart attack strikes, the most effective way to unblock the blocked heart artery is through an interventional procedure called coronary angioplasty. This is done by inserting a stent through a small puncture in the groin or wrist to open up the artery, successful in over 95% of the cases. This procedure, which is also known as percutaneous coronary intervention (PCI), is the gold standard of care for a heart attack.
Interventional cardiology involves treating patients with disease of the heart vessels, known as coronary artery disease. The interventional procedures are minimally invasive and carried out in the cardiac catheterisation laboratories, which is operational round-the-clock at NHCS, to ensure that patients suffering from heart attacks are able to receive prompt treatment.
Then Versus Now
One of the key improvements in interventional cardiology is the development of stents used in interventional procedures. Stents are tiny metal mesh tubes that are placed in the artery. The first-generation stents which were introduced in 1986 were much bulkier, making it hard to deliver them into the narrowed segments of the artery.
While cardiologists may have implanted stents with great success back then, the stents did not have a medicated coating, which led to a re-narrowing of the arteries in four out of 10 patients. Some 15 years on, in 2001, stents came with special medication coatings, which greatly revolutionised the way coronary angioplasty is performed. The incidence of re-narrowing of an artery has since fallen to single digits.
“When we first carried out catheterisation procedures, it took up to two hours to complete a straightforward case without complications. Now, it only takes 30 minutes,” Prof Koh shared on how the cases have since evolved through the years. “Our current capabilities have also expanded tremendously. We used to be doing only single-vessel cases, but now we regularly work on complex multi-vessel cases.”
Interventional Cardiology in Singapore
Singapore is a cosmopolitan city that offers 24-hour PCI for patients with heart attacks, which is an advantage over many countries due to the size of Singapore, its efficient infrastructure and medical expertise which make commuting and access to healthcare relatively easier and faster. This is not the case, however, for many other countries who are still providing their patients with the traditional treatment of thrombolytic therapy, which is the use of drugs to break up or dissolve blood clots, even though PCI has been proven to provide better clinical outcomes.
Heart attack patients who need coronary interventions are receiving faster help than in the past. This door-to-balloon time, a measure of the duration from when a patient arrives at the emergency room to receiving primary PCI, is currently at the recommended 90 minutes or less, in accordance to the American Heart Association guidelines, a benchmark where all Singapore hospitals work hard to adhere to. The very first ‘live’ interventional cardiology conference was held in October 1989.
SingLIVE – Asia's Leading Interventional Cardiology Event
The Singapore LIVE (SingLIVE) interventional cardiology conference was started 28 years ago and it has since remained as one of Asia’s pre-eminent annual courses in cardiac interventions. This flagship event of NHCS is an international cardiology conference showcasing the latest interventional techniques in cardiac and peripheral angioplasty procedures, as well as “live” transmission of procedures to enhance the learning experience. Year after year, SingLIVE attracts a large number of medical professionals from Singapore, Asia-Pacific and around the world.
The idea of a “live” interventional cardiology conference originated from NHCS’ founding father, Assoc Prof Arthur Tan, who is also SingLIVE’s first Course Director, in 1989. However, it was then known as ‘First Live Demonstration in Basic and Advanced Techniques of Percutaneous
Transluminal Coronary Angioplasty’ and was held at the auditorium of the College of Medicine Building, Ministry of Health, near the Singapore General Hospital.
Having been the course director of SingLIVE since 2003, Prof Koh fondly recalled the very first SingLIVE event that he had participated in. “The year was 1998. Everything was very new to us then, yet it was special. We had only one catheterisation lab in which we performed about six cases over the three-day period of the conference.”
The turnout for the inaugural SingLIVE conference in 1989 was just 200 participants, but it has since grown to over 2,000 local and international participants in recent years. Prof Koh and his team have gone on to organise the yearly SingLIVE event for 28 years. “Many medical courses had come and gone. But we are still around and that is a significant feat for us.” The SingLIVE faculty has also expanded to include many Asian key opinion leaders and experts, elevating it to a higher plane to become a key premier live interventional course in Asia Pacific.
“It’s a very exciting era for us, interventional cardiologists, to be in”, Prof Koh enthused. “There have been many innovations and improvements in the treatment of cardiovascular disease by interventional means over the last two to three decades. We have witnessed new, innovative use of stents and technological advancements not just in the area of coronary circulation but also in the development of interventional cardiology. For example, we can now administer treatment for structural heart disease, by replacing heart valves through Transcatheter Aortic Valve Implantation (TAVI).” TAVI, also known as percutaneous aortic valve replacement, is a minimally invasive procedure to correct severe aortic stenosis, which is the narrowing of the aortic valve opening.
When asked what kept him motivated in this field, Prof Koh visibly lit up as he went on to talk about all the latest advancements in interventional cardiology. “It is a very exciting field. For any aspiring interventional cardiologist, it does take quite a bit of hard work, especially when working on the night shifts. The hard work will eventually pay off and the outcome will be gratifying. It is only through this that we can continue to make remarkable progress in what we do. For instance, we are now even looking at using interventional devices to treat hypertension.”