Seth,

I want to apologize to you for our colleagues who referred to those of you on the front lines who get up at 2 am and save lives out in the periphery as "bottom feeders".  I am not an interventionalist but I have taken many a patient to the cath lab, performed their cath with ST's up, inserted an IAPB where necessary, temp pacer, etc. and in the old days prior to our having an approved PCI program WITHOUT SURGERY On-SITE), walked down the long hall to tell the anxious family that we are sorry, we did all we could do.  Fast foward to a community that has this luxury of stopping a heart attack at the point of care.  For those who can make it onto our table, we don't have to take that long walk down the hall anymore. To stand and point fingers at those who make great sacrifices of family time to serve a dying population Is at the least inconsiderate. Let them stand in our ER on an icy day in winter with no transfer capability and watch as a 45 year mother kills her LV from failed lytic.  They need to spend a little time in that position in order to understand our predicaments.  THen, logically, if you can do the shocky and dying well, you need to be able to do the non-emergent in order to be able to employ a team and keep them proficient at doing the emergencies. 

Forgive me but I do want to take issue with one point you made. You referred to non STEMI's as "elective" when in fact, I'll bet most of your cases you referred to as "elective" are in fact patients that came in with chest pain, leaking trop's etc. We refer to these often as "elective" when in fact, they are not.

Keep up the good fight to save a population that is often forgotten by those fat and happy PCI labs at larger centers who think nothing of them until the ambulance is rolling toward them with a trop of 20.  You guys in the trenches deserve accolades and gratitude. Here's mine.

Melissa

Seth,  Thanks you for a well very well conceived and executed explanation of PCI in non-urban areas.  As an interventionist prviding STEMI care in a rural area of Missouri I have personally witnessed not only lives being saved, but equally as important lifestyles being maintained for our rural patients.  In the past, if you were a farmer or worked in other "non-urban' industry your cardiac healthcare was doomed to be "second rate" if you had the misfortune to present with an acute MI.  Ihave practiced in several ciites over my 25 year career so far, and I can truly say that the physicians and staff here in Hannibal, MO. are some of the most dedicated and caring with whom I have ever been associated.  The desire to provide top quality care to thousands of patients in this setting requires a different kind of dedication.  On-call schedules are always every other night and every other weekend since there are only 2 interventionists serving our hospital and, while the pay is equivalent to that in a larger city, the lifestyle amenities are fewer making it more difficult for our spouses and families.  Thanks again for supporting the proven safety and efiicacy of PCI without SOS.  "Bottom Feeder" is certainly a distasteful term, but I have been called worse things in my life and I am still very happy providing cardiac interventional care in middle America

Sincerely,

Mark A Shima, MD,FACC, FACP, FSCAI 

Our "Bottom-feeder" colleague is an electrophysiologist with Fort Wayne Cardiology.  I was unable to reach him by phone for clarification.  I did leave meassages for him and administration:  (260) 481 - 4700.  Please give them a call, perhaps he was misquoted.

 (heartwire) According to Dr Michael Mirro (Fort Wayne Cardiology, IN), "This is about money most places—small hospitals trying to compete and bottom-feeder interventionalists. Some rural areas in the West do need to do this but should be granted a waiver."

(Copied from the Fort Wayne Cardiology website)Michael J. Mirro, M.D.

Dr. Mirro specializes in the field of cardiac electrophysiology and clinical research.

FORT WAYNE CARDIOLOGY

OUTPATIENT CATH LAB

INSTRUCTION SHEET

1. You are scheduled for an Outpatient Cardiac Catheterization at Fort Wayne

Cardiology’s main office at 1819 Carew Street

2. Report to the Fort Wayne Cardiology Outpatient Cath Lab (in the lower level of

Fort Wayne Cardiology). Please arrive on time.