William S. Weintraub, M.D., F.A.C.C.
William S. Weintraub, M.D., F.A.C.C.
Chair of the CathPCI Steering Committee, American College of Cardiology Foundation, Washington, District of Columbia
Director, Division of Cardiology, Christiana Care Health System, Washington, District of Columbia
ACCF-STS Database Collaboration on the Comparative Effectiveness of PCI and CABG
Administered by the NHLBI Division of Cardiovascular Sciences, Clinical Applications and Prevention Branch
FY 2009 funding: $2,655,996
Research Focus: What is the best treatment for blocked arteries: bypass surgery or angioplasty? Coronary artery disease ranks as the top cause of death in American adults, so the question of which of these revascularization procedures is best under which circumstances, is one of the most important in medicine.
A "Grand Opportunity" grant, awarded in September 2009 by the National Heart, Lung, and Blood Institute (NHLBI) through American Recovery and Reinvestment Act (ARRA) funds, will support a comparative effectiveness study of coronary bypass artery bypass grafting (CABG) versus angioplasty. In CABG, also known as bypass surgery, blood flow to the heart is improved by connecting, or grafting, a healthy artery or vein from another part of the body to the blocked coronary artery. Angioplasty, also referred to as percutaneous coronary intervention (PCI), is a less invasive procedure, in which blocked arteries are opened with a balloon or, more frequently, stents inserted in a coronary artery.
"In the United States, we do over a million angioplasties and 500,000 cardiac surgery procedures a year, and yet we have inadequate data to help doctors decide between procedures," said Dr. Weintraub, who serves as chief of the cardiology department at Christiana Care in Newark, Del., and chair of the ACCF's CathPCI Registry® steering committee. "[This project] is our best possibility for better understanding the best choice for different patients."
Researchers will compare the effectiveness of these two procedures by combining data on approximately 80,000 patients from the databases of the American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) with the MEDPAR database of the Centers for Medicare and Medicaid Services.
This combined set of data will allow Dr. Weintraub, the project's co-principal investigator, Fred Edwards, M.D., and their team to assess long-term clinical and cost outcomes of angioplasty and bypass surgery, including hospitalizations, subsequent heart attacks, the need to repeat revascularization procedures, and patient survival. The researchers will also analyze subsets of data to look at interactions with age, gender, and other medical conditions, such as stroke and kidney failure. If this comparative effective approach is successful, it could be used as a template for comparing other commonly performed medical procedures.
Dr. Edwards is a professor of surgery and medical director of cardiothoracic surgery at the University of Florida/Shands Jacksonville and serves as chairman of the STS national database. He developed the first national risk-adjustment models in cardiac surgery and has had a key role in all subsequent STS risk models.
Economic Impact: The project will employ 16 investigators from among the five collaborating organizations: Christiana Care Center for Outcomes Research (CCOR) in Newark, Del.; the ACCF in Washington, D.C.; the STS in Chicago; Duke Clinical Research Institute (DCRI) in Durham, N.C.; and PERFUSE Angiographic Core Laboratories & Data Coordinating Center, a non-profit academic research organization in Boston.
According to the ACCF, 19 people in addition to the investigators, several of whom represent anticipated new hires, will work on the grant, including coordinators and statisticians. "The amount of analytic work that's going to be involved in this project is through the roof," said Dr. Weintraub. "It's not something we could take on without NHLBI's ARRA funding."
A Typical Day: As the head of the cardiology department, the health outcome center, and the fellowship training program at Christiana Care as well as the principal investigator on this grant and others, Dr. Weintraub typically works a 12-hour day.
"I arrive for a morning conference at 7 a.m., check how things are going clinically and how our fellows are doing, and make sure they haven't had any problematic cases," he said. "Usually I'll have a number of calls about research projects. Sometime in the afternoon, I will work with the other epidemiologists and biostatisticians on their projects. And, if I'm lucky, I will have a couple of hours to work on my own, writing new grants."
"The most important thing for me creatively is working with young people, people in training or with junior faculty, working through ideas with them. I try to help other people with their research. For example, a new faculty member in gynecology wants to compare robotic with non-robotic surgery," added Dr. Weintraub. "We're going to apply a lot of the same analytical methodology in this [NHLBI ARRA-funded] grant to that project, and that will be very new in gynecology. The analysis techniques used in this project should have broad application to the entire field of medicine."
"The Path is Through Public Health": "I always knew I was interested in science," said Dr. Weintraub. "I trained in the 1970s, and I knew from the beginning that I wanted an academic career. It was apparent to me even then that there were tremendous issues in understanding our health outcomes, even though outcomes research didn't exist then as we understand it now.
"If I could be a basic scientist and come up with a way to prevent cardiovascular disease, I would, but I think the path is through public health research. So I am working to help improve both public health and to help improve the way we live our lives so we prevent obesity, [avoid] cigarette smoking, and encourage exercise. Then we would have a lot less cardiovascular disease and we wouldn't have to do studies like this one."
By Sheila Walsh