heartwire has confirmed that prominent members of the interventional cardiology community lobbied industry and their peers to break away from the ACC after the ACC 2007 Scientific Sessions, at one time floating the idea of launching a new spring interventional meeting to compete directly with the ACC's i2 Summit. In a letter sent to then-ACC president Dr James Dove, members of industry and the interventional community complained that the ACC had failed to create "a fair and balanced process" during the 2007 meeting and permitted personal agendas to take "center stage" in a way that left interventionalists feeling "disenfranchised" and "alienated." In particular, many interventional cardiologists felt that the COURAGE trial was unfairly represented to the press and that the sanctioning of Dr Martin Leon (Columbia University, NY) for his alleged embargo break during an ACC satellite symposium was, according to the letter, unduly harsh, creating a "schism" between interventionalists and general cardiologists.

On the industry side, the four major drug-eluting-stent (DES) manufacturers—Cordis/J&J, Boston Scientific, Medtronic, and Abbott—calling themselves the "PCI coalition" and represented by the trade group Advamed, announced they would be pulling their funding from the ACC/i2 Summit unless the ACC meeting merged with that of the SCAI, usually held in May. According to ACC CEO Dr Jack Lewin, these four companies did indeed come back to the table when the two societies agreed to merge their meetings, ending up being the biggest supporters of this year's SCAI meeting, held in conjunction with the ACC/i2 Summit. According to Lewin, these companies paid the SCAI "well over" $2 million in total, representing both educational grants and exhibition expenses. Dr Bonnie Weiner, SCAI president, hinted that the amount was even higher, referring to over $3 million in educational support alone, not including booth space in the exhibition hall. According to exhibitor information available through the ACC's website, booth payments to the ACC ranged from $120 000 from Cordis for 4000 square feet, to $192 000 from Abbott for 6400 square feet.

Both Advamed and several of the companies they represent that were contacted by heartwire declined to disclose actual amounts.

But both Lewin and Weiner are adamant that company funding was not the main reason behind the 2008 merger and will not guide decisions for 2009.

Yes, industry indirectly probably expressed some desire last year in terms of trying to bring the two meetings together, but that was really not the deciding factor in the decision last year to partner with the ACC, and it won't be in the future.

"No way!" said Lewin. "It wasn't like that at all. What [the companies] said was that they could not and were not going to continue funding multiple meetings around the same time of the year and trying to put up expositions in multiple locations. They just said, we don't have the resources to keep doing that. So all of you are going to get less and less each year, unless you can come together, in which case we can continue to fund at a level that might produce a good meeting."

Weiner, likewise, downplayed industry's influence. "Yes, industry indirectly probably expressed some desire last year in terms of trying to bring the two meetings together, but that was really not the deciding factor in the decision last year to partner with the ACC, and it won't be in the future. Industry is our partner, just as they are for the college, and let me be clear and definitive: it is not making this decision; we are."

Dr Bill Knopf, who has been a program cochair for the ACC/i2 Summit since its inception in 2006, called the merged SCAI-ACC/i2 sessions "a tremendous meeting" and said that industry's role in the marriage has been "blown out of proportion."

"Advamed was sending a message to both SCAI and the ACC that they needed to work toward having one spring meeting, and the way that they did that may not have been the best way of doing it," he acknowledged. "But the end result is what we're all interested in, and that was a huge success. In terms of withdrawing, withholding, or not giving resources, that never materialized. So I can't tell you what would have happened had it materialized. I think it was basically an opportunity for industry to really demonstrate what they wanted, and it worked, because it got the two societies to talk to each other and come up with a solution."

Advamed, for its part, insists it was only acting in the best interests of industry, physicians, and patients.

"Our member companies felt ACC and SCAI, the nation's two leading societies for cardiologists and cardiology professionals, would better foster interaction between interventional cardiologists and general cardiologists through a combined meeting rather than through two separate meetings held within months of each other," an Advamed statement to heartwire reads. "As leaders in the PCI medical-device community, it's only natural that our member companies have a significant interest in improving educational opportunities for physicians and others to learn about advancements in the field of cardiology."

Organizers also dismissed talk of the so-called "schism" between interventional and general cardiologists, pointing out that interventional cardiologists also practice general cardiology and are members of the ACC.

If physicians, and some of our membership, are motivated by the pocketbook, the college isn't going to make them very happy, because we are going to try and stick to the science.

"Yes, I think there was a feeling last year that the ACC did not help present a balanced view of some of the content that was coming out, and I think that created a media experience that tended to pit one of us against the other, but that was less reality," Weiner said. "I'm not saying there aren't people within each group who tended to want to inflame that to a certain degree, but the realities are that we are better off together in terms of the kinds of challenges that healthcare in general is facing, but there will be times when we disagree. And that's healthy. But I would not in any way at this point characterize it as a 'schism.' "

Lewin, similarly, characterized the rift as being "in the mind of a very small number of people who have a lot of their own personal agendas engaged in this." Some of the interventional outcry over COURAGE, he suggested, which showed PCI to have no benefits over a cheaper strategy of optimal medical therapy in patients with stable coronary artery disease, may have been driven by fears of financial losses.

"The college may get in the way of some people who are looking at pocketbook issues: if physicians, and some of our membership, are motivated by the pocketbook, the college isn't going to make them very happy, because we are going to try and stick to the science."

Overall, Lewin believes the COURAGE results last year were handled "very, very fairly."

"I just don't think that people liked the results," he continued. "I think the results were painful, but what's happened a year later is that the same painfulness has largely been modified by virtue of a great deal of work that points out the safety of DES. . . . I think you could say that DES were exonerated at this year's conference. And that wasn't because we played some kind of politics or because we're trying to be especially friendly to interventionalists; that's what the science is."

Both Lewin and Knopf gave glowing reviews for the 2008 merged meeting, pointing out that registration was up, educational content was excellent, and member feedback has been positive. According to Knopf, 80% of the 4400 registrants for the i2-SCAI program also registered for the ACC meeting, suggesting that interest in attending sessions at both meetings was high. Both men told heartwire that from the ACC and i2 perspective, they would like the SCAI-ACC marriage to last.

"The ACC board is unanimously in favor of a continued partnership with SCAI for the interventional side of our meeting," Lewin said. "We also know that we don't want to swallow up their identity because we are the 800-pound gorilla next door, so we need to be very cognizant and make sure that their identity isn't lost in the process."

For cardiologists not involved in the behind the scenes politicking, reaction has been mixed. Dr Chad Rammohan (Camino Medical Group, Mountain View, CA), said that at this year's meeting he found himself attending the SCAI sessions, then trying to catch up on the ACC material online. "I am a busy private-practice interventional cardiologist; it is difficult for me to get to more than one big meeting a year," he acknowledged. That said, "The ACC is already a very large meeting and the combination is overwhelming. It was a little difficult to plan which sessions to attend."

Dr Mark Turco (Washington Adventist Hospital, Tacoma Park, MD), a long-term attendee of SCAI who is now a member of the board of trustees for the society, emphasized the need for the two groups to present a "unified front" and pointed to the obvious benefits of mutual education that can take place at a combined meeting venue. But Turco has some misgivings about the risk to the SCAI's "identity" and "culture." He's concerned about the SCAI meeting losing its "intimate feel," easy interaction between attendees and faculty, and annual benchmark lectures and forums that have become a part of the SCAI "brand."

Pressed to define precisely how the "cultures" differed, Turco emphasized the sheer size and scope of the ACC.

If you have a bad marriage, at some point the marriage breaks up.

"The difference is, you are dealing with a very large corporation vs a small group, and you can imagine how hard it is at times to get things done—there is a lot more in the way of political past and red tape within the ACC than there is within the SCAI," he said. "There are committees to have committees to have committees within the ACC, vs more of a 'let's sit down and get this done today attitude' within the SCAI."

Asked whether the COURAGE rift might also be defining the two cultures in 2008, Turco was circumspect.

"Are there still hard feelings from last year's ACC and the outcome of that meeting? I would tell you there are some people who still have hard feelings. Do I think they are playing a role in a try-to-get-even situation? I would tell you that's not the case. Most of us are smart enough to know that there are enough issues within the field of cardiology that it is much more important for us to unite on those issues than to fight internally at this time."

Both the SCAI and ACC are taking the rest of April to solicit feedback from their constituents and board members and to meet with industry before making a final decision. Weiner agreed that the merged meeting went very well "from an educational standpoint" but alluded to details that still needed to be ironed out if a merger was to become permanent. "What we're trying to work through is how to maintain the identity of the smaller but focused interventional organization in the context of 30 000 general cardiologists," she told heartwire. "It's important to understand that this is not a battle—that's not even the right word. If we decide to do this again it's because we all agree it's the right thing to do. If we decide not to do this type of meeting again, it's because we all think it's the right thing to do for our respective organizations."

Turco agreed. "I think there are possible ways to make this integrated form work, the thing is that the two cultures need to get together and really agree on the format. If you have a bad marriage, at some point the marriage breaks up. If you, as the husband and wife, decide you want to make it work, and you go for counseling and try to bring it together, you can make it work somehow. It's going to take cooperation on both sides."

Asked where its member companies will be spending their dollars next year, an Advamed spokesperson said the group is waiting to see whether the SCAI and ACC decide to partner in 2009 before making any decisions.