4:00-4:20 p.m. Welcome & Introduction—Top Ten Advances of STEMI Interventions 2008
Sameer Mehta, MD
Management of STEMI is undergoing revolutionary changes — both in the procedure as well as in the process of the STEMI intervention. New data are constantly emerging from across the globe as door-to-balloon (D2B) times become the new mantra for successful STEMI interventions. New drugs, devices, and efficient techniques incorporate the procedural enhancements, whereas process improvements are being reported from various institutions and regional STEMI population-based STEMI systems. These advances are integrated in the introductory lectre by the Course Director, Dr. Sameer Mehta.

4:20-4:40 p.m. Deconstructing the STEMI Chaos
William Hamman, MD
Teamwork is critical for successful STEMI interventions. The STEMI team is comprised of the EMS, ED, and the CVL, with vital support stemming in from the local administration at the respective institution. Training, ethics, speed, skills, efficiency and communication are dramatically different for the STEMI key players. These unique characteristics come into play during a STEMI intervention and can carry the potential of causing complete chaos, which could be severely detrimental to the well-being of the critically ill patient. Dr. William Hamman, a veritable world expert, cardiologist and process management guru, deconstructs the STEMI chaos.

4:40-5:00 p.m. Door 2 Balloon Times—Clinical Relevance & Pragmatic Methods of Reducing D2B Times
Brahmajee Nallamothu, MD
A pioneer in the D2B time strategies for STEMI interventions and a lead authority on STEMI processes, Dr. Brahmajee Nallamothu draws upon his vast experience with D2B times to recommend system improvements. Core quality measures, the D2B alliance, and ACC initiatives regarding D2B times are also reviewed.

8:00-8:20 a.m. Presidential Address: STEMI Interventions—What We Know and What is Still Missing
W. Douglas Weaver, MD, President, American College of Cardiology
STEMI interventions are a critical initiative of the American College of Cardiology. In addition, STEMI guidelines are constantly being updated to include findings from clinical trials and new developments in the field. ACC President Dr. Douglas Weaver provides his personal perspectives regarding the present status and future challenges for STEMI interventions.

8:20-8:40 a.m. Technical Pearls from the Master – Complex Coronary Interventions
Samin Sharma, MD
Superior PCI techniques are critical to the performance of STEMI interventions, which will often test the speed and skills of the operator. The broad topic “Technical Pearls from the Master” incorporates the entire gamut of complex coronary interventions. Dr. Samin Sharma, a LUMEN Course Co-Director, provides important and pragmatic lessons for performing complex coronary interventions.

8:40-9:00 a.m. Pathology of the STEMI Lesion & the Role of Thrombus
Renu Virmani, MD
Some of the best lessons in PCI have been learned from pathophysiology correlates. In terms of STEMI, this relationship has been even more enlightening. The irrevocable evidence from necropsy teaches us that thrombus plays a critical role in a STEMI lesion. Dr. Renu Virmani, a world-expert pathologist, provides invaluable insights about the STEMI lesion and provides a framework for its therapeutic management.

9:00-9:20 a.m. Ten Commandments for STEMI Interventions and Lessons Learned from the SINCERE Database
Sameer Mehta, MD
The procedural aspects of a STEMI intervention are reviewed in this practical lecture, which is laced with illustrative cases. The importance of focusing on the “culprit lesion” and the compulsive management of thrombus are emphasized. Selection of hardware for a PCI intervention is also discussed. Additional technical tips for performing a STEMI intervention, as practiced in the SINCERE database, are reviewed by the Course Director, Dr. Sameer Mehta.

9:20-9:40 a.m. Novel Tools in STEMI Interventions: Intracoronary Drug Delivery, Thrombectomy Devices, & More
Rajesh M. Dave, MD
Numerous recent American and European trials have advocated the use of intracoronary drug delivery and thrombectomy for successful STEMI interventions. This clinical evidence provides a scientific rationale to apply these techniques for primary PCI and to obtain superior outcomes. In addition, these applications are generating robust device developments specific for STEMI interventions. A top advocate in this field, Dr. Rajesh Dave, provides an update on the status of these new tools that add to our arsenal.

9:40-10:10 a.m. Lumen Keynote Address: New Modalities for STEMI Interventions
William O’Neill, MD
A world expert in the field of STEMI interventions, Dr. William O’Neill provides an illuminating review of the new modalities that are emerging in Primary PCI. Future developments of drugs, devices, techniques, and processes related to STEMI interventions are discussed.

Recommended reading from the speaker

10:10-10:30 a.m. Break

10:30-12:30 p.m. STEMI Processes Symposium – The World’s Best

1. The Mayo Clinic
Charanjit Rihal, MD
2. RACE Program
James Hoekstra, MD
3. Citywide Protocol for Ottawa
Michel Le May, MD, FRCPC
4. Minneapolis Heart Institute at Abbott Northwestern Hospital STEMI Program
Timothy Henry, MD
5. SOCAL - Southern California Systems
Ivan Rokos, MD
Moderated Discussion, Q & A
This strongly recommended symposium will provide a comprehensive review of the best STEMI programs in the world. Five world-class regional STEMI systems are highlighted for their outstanding contributions to global STEMI care. Key investigator s from the respective systems will review their STEMI process and offer tips for individuals and institutions that are in the process of designing their STEMI systems. A round table discussion and moderated Q & A session will follow the presentations.

Recommended reading from the speaker

12:30-2:00 p.m. Lunch/Exhibits Open

2:00-4:00 p.m. STEMI Workshops A (CHOOSE ONE)

Workshop 1 – STEMI EKG Certification
Chairperson: Simon Chakko, MD
Panelists: Luis Correa, MD, Hector Jimenez, MD, Carlos Alfonso, MD, Fernando Perez, MD
LUMEN 2009 will offer the first-ever STEMI EKG Certification Course. The workshop will consist of lectures on the basic STEMI EKG and focus on numerous tips to augment the accuracy of EKG in diagnosing STEMI. There will be ample illustrated examples, and the important correlation of the STEMI EKG and the coronary angiography will be demonstrated. An EKG test will also be administrated; successful candidates will be provided a LUMEN EKG Certificate.
Target audience– internists, ED physicians, nurses, fellows-in-training, VCRT, EMT.
Recommended reading from the speaker
Workshop 2 – STEMI Teamwork: Learning from Simulation
Chairperson: William Hamman, MD
Panelists: Eva Kline-Rogers, RN, J. Brent Myers, MD, Xavier Anton, MD, Thomas Alexander, MD
Dr. William Hamman is a commercial pilot, cardiologist and systems expert who has done innovative work using simulative techniques to improve patient safety and process efficiency for numerous medical specialties and procedures. His pioneering work has particular significance for STEMI interventions; it is the recipient of numerous grants and comprises of ACC initiatives regarding the role of medical simulation. In this remarkable workshop, Dr. Hamman will demonstrate, via the use of myriad simulation techniques, the vital importance of teamwork for successful D2B interventions. The entire STEMI intervention is simulated, and the critical interplay of the EMS, ED and EMS personnel is revealed. Through this workshop, attendees will be able to identify the system deficiencies and learn from world experts some pragmatic ways to improve their respective STEMI programs.
Target audience – interventional cardiologists, ED physicians, CVL and EMS personnel, hospital administrators, healthcare payers, press, general attendees.
Recommended reading from the speaker
Workshop 3 – STEMI Interventions CINE Review
Chairperson: Sameer Mehta, MD
Panelists: Ralph Nader, MD, Vinod Jorapur, MD, Faisal Shamshad, MD, Rosanna Briceño, MD
In this interactive workshop, the LUMEN Course Director, Dr. Sameer Mehta, will use a compendium of cineangiograms to teach practical tips for performing STEMI interventions. Up to 20 selected cases will be demonstrated, ranging from the simple STEMI intervention to more complex D2B procedures. Emphasis will be placed on the use of standardized techniques for STEMI intervention, practical tips of lowering D2B times, selection of PCI hardware, and a review of thrombectomy devices and techniques. The critical issues of identifying the culprit STEMI lesion and effective strategies of STEMI interventions using the thrombus grade for compulsive management of thrombus will be discussed. Other practical lessons derived from the SINCERE database will also be reviewed.
Target audience – interventional cardiologists, fellows-in-training, CVRT, nurses.
Recommended reading from the speaker

4:30-6:00 p.m. STEMI Workshops B (CHOOSE ONE)

Workshop 4 – STEMI Critical Nursing Issues
Chairperson: Barbara Unger, RN
Panelists: Eva Kline-Rogers, RN, Grisel Fernandez-Bravo, RN, John Cochrane, RN, Josen Thomas, RN, MBA
Efficient, rapid and skilled nursing care is critical to a successful STEMI intervention and especially for achieving short D2B times. Seamless nursing care is important for the care of the sick STEMI patient who is rapidly triaged through ED, the CVL and Intensive Care. Critical and unique nursing issues emerge during this vital transition. Top nursing experts, including the Lumen Course Co- Director, Barbara Unger, RN, will review their own programs and discuss the valuable lessons they have learned in the delivery of care to these patients. Effective management strategies for efficient triage will also be discussed. Staffing issues, nursing shortage, special nursing skills and trouble shooting will be candidly shared during this workshop.
Target audience – interventional cardiologists, fellows-in-training, CVRT, nurses.
Recommended reading from the speaker
Workshop 5 – Adjuncts to STEMI Interventions
Chairperson: Samin Sharma, MD
Panelists: Charanjit Rihal, MD, Rajesh Dave, MD, Sameer Mehta, MD, Brahmajee Nallamothu, MD, Thomas Alexander, MD
The top LUMEN faculty assembles in a single workshop to deal with the very important subject of “Adjuncts to STEMI Interventions.” The session is chaired by Dr. Samin Sharma, a recognized world expert and opinion leader in PCI, as well as by our expert panel of highly-skilled interventional cardiologists. The various aspiration and thrombectomy devices will be discussed, and practical tips of their application will be reviewed. Intracoronary drug delivery and experience with numerous specialty catheters will also be discussed. The very significant issue of LV support devices will be examined, and illustrative cases will be utilized to demonstrate the effective use of these important devices. Newer and emerging modalities in STEMI interventions will also be discussed during this practical, interactive session.
Target audience – interventional cardiologists, fellows-in-training, CVRT, nurses, CV surgeons.
Recommended reading from the speaker
Workshop 6 – CEO Summit: Lessons for Administrators
Chairperson: Monica Manasa, MD
Panelists: James Hoekstra, MD, William Hamman, MD, Ivan Rokos, MD, Timothy Henry, MD, Andrew Moss, Esq.
A successful STEMI program can simply not exist without the close involvement, cooperation and support of the hospital administrators! The hospital administrator may be the missing link in a STEMI intervention. In recognizing the critical role of the administrators in STEMI interventions, LUMEN 2009 has designed this very special workshop. Several important administrative issues will be discussed in a candid appraisal of the STEMI process and procedure. Experts from some of the world’s best STEMI programs will discuss how they were able to obtain local and regional support for their individual programs. They will also share their perspectives about the contributions of STEMI initiatives for social awareness, philanthropy and education. System improvements, including upgrading of facilities and eliminating redundancies, will be reviewed. Cost-effective strategies and marketing initiatives will be evaluated. The critical aspects of data management and core CMS initiatives will be discussed in an interactive environment. Quality assurance, peer review and legal issues pertaining to STEMI interventions will be appraised. Finally, the care and cost of providing STEMI care to the multitude of unfunded patients will be opened for discussion and for expert panel analysis.
Target audience – hospital and nursing administrators, healthcare executives, physicians, nurses, investors, press, laypersons.
Recommended reading from the speaker

8:00-8:20 a.m. The Challenge to Develop STEMI Systems of Care: AHA’s Mission Lifeline
Alice Jacobs, MD
A former President of the American Heart Association (AHA), Dr. Alice Jacobs, provides an uplifting message for attendees and reviews the AHA perspectives regarding STEMI. The superb initiatives of the “Mission Lifeline” are presented, and the critical need of STEMI education is emphasized.

8:20-8:40 a.m. Pre-Hospital Activation, Triage, & Transfer—The EMS Perspective
J. Brent Myers, MD
Experts have proposed that the best strategy for achieving D2B times for STEMI interventions is to backwardly integrate the STEMI management process to the prehospital stage. This enables early diagnosis, STEMI alert activation, effective triage using bypass protocols, initiation of pharmacological management and management of complications. An expert in EMS strategies shares his perspectives and offers pragmatic solutions for better STEMI management.

8:40-9:00 a.m. The 80-Lead EKG and Other Innovations—The ED Perspective
James Hoekstra, MD
The past president of the American Society of Academic Emergency Medicine and a LUMEN Course Co Director, Dr. James Hoekstra, shares the critical ED viewpoint on STEMI interventions. He discusses the vital contributions of effective ED management to the outstanding success of the RACE system of regional STEMI care in North Carolina. Innovations in enhanced EKG diagnosis, including the revolutionary 80-lead EKG, are discussed.

9:00-9:20 a.m. Antiplatelets, Anticoagulants, Direct Thrombin Inhibitors, & Newer Agents—The Pharmacological Management of STEMI Interventions
Dean Kereiakes, MD
Appropriate pharmacological management is crucial to the success of any STEMI intervention. The menu of choices with the availability of numerous antiplatelets, anticoagulants, direct thrombin inhibitors and several other newer agents for use in STEMI interventions also makes it difficult to choose the optimal pharmacological agents for a STEMI intervention. The appropriate timing and dosing of these agents is important as well — these, along with numerous other pertinent pharmacological issues and the relevant guidelines, are reviewed by Dr. Dean Kereiakes in this very important didactic session.

9:20-9:40 a.m. The Relevance of Thrombolytic Therapy in the Era of STEMI Interventions
Michael Mooney, MD
Despite the superiority of primary PCI over thrombolytic therapy being demonstrated in numerous clinical trials, thrombolytic therapy remains a mainstay of STEMI management in facilities where primary PCI does not exist. A pharmacoinvasive strategy is offered as effective STEMI management in numerous population-based STEMI programs. In this important lecture, Dr. Michael Mooney discusses these vital issues regarding the status of thrombolytic therapy. In addition, the role of facilitated PCI, facilitated thrombolysis, failed lysis and salvage PCI, as well as the guidelines for coronary angiography after thrombolytic therapy, are discussed.

9:40-10:10 a.m. Lumen Keynote Address: Coronary Interventions, Present Status & Future Perspectives
Martin B. Leon, MD
In this LUMEN keynote address, a luminary in the field of interventional cardiology, Dr. Martin Leon, provides his mature vision about the present status and future perspectives of coronary interventions. It is hoped that this broad and all-encompassing lecture will considerably enhance the knowledge of the interventional and clinical cardiologists, and inspire all attendees.
Recommended reading from the speaker

10:10-10:30 a.m. Break

10:30-11:00 a.m. Take-Home Lessons from STEMI Clinical Trials
Cindy Grines, MD
Dr. Cindy Grines easily qualifies as a pioneer in STEMI interventions; her initial work is considered landmark and laid the foundation for primary PCI globally. Her outstanding work is cited in almost every STEMI publication. Her dynamic work in primary PCI has also been the source of continued advancements in the field. Using this very relevant topic, Dr. Grines reviews pertinent STEMI trials and provides us with the important take home lessons these trials offer.
Recommended reading from the speaker

11:00-12:30 p.m. STEMI Interventions – The Great Debates

Which Stent to Use in Primary PCI?
DES is the Way to Go (Charanjit Rihal, MD) vs. Forget Those Tiny, Ticking Time Bombs, BMS All the Way - (Renu Virmani, MD)
Where to Perform Primary PCI?
High Volume, Tertiary Centers - Michel Le May, MD vs. More Centers, Without Surgical Back Up - Alice Jacobs, MD
Moderated Discussion, Q & A
There are two major topics to debate regarding the status of STEMI interventions in 2009: which stent to use for STEMI interventions, and whether these interventions should be performed only at large tertiary centers. At LUMEN 2009 both topics will be debated by world experts in Primary PCI. In the first debate entitled, “Which stent to use in primary PCI?,” Drs. Rihal and Virmani will provide keen insight and valuable data for their stent recommendation. During the second debate on the other critical issue, “Where to perform primary PCI?,” the past president of AHA, Dr. Alice Jacobs, will provide her reasons why primary PCI should be performed at more centers, without the need for surgical standby. Dr. Alice Jacobs is opposed by a top expert, Dr. Michel Le May, who is the lead investigator of the Ottawa Citywide Protocol for Primary PCI. Dr. Le May proposes that primary PCI should be performed at tertiary care centers.

Recommended reading from the speaker

12:30-2:00 p.m. Lunch/Exhibits Open

2:00-4:00 p.m. STEMI Workshops C (CHOOSE ONE)

Workshop 7 – STEMI EKG Certification
Chairperson: Simon Chakko, MD
Panelists: Luis Correa, MD, Hector Jimenez, MD, Carlos Alfonso, MD, Fernando Perez, MD
LUMEN 2009 will offer the firstever STEMI EKG Certification Course. The workshop will consist of lectures on the basic STEMI EKG and focus on numerous tips to augment the accuracy of EKG in diagnosing STEMI. There will be ample illustrated examples, and the important correlation of the STEMI EKG and the coronary angiography will be demonstrated. An EKG test will also be administrated; successful candidates will be provided a LUMEN EKG Certificate.
Target audience – internists, ED physicians, nurses, fellows-in-training, VCRT, EMT.
Recommended reading from the speaker
Workshop 8 – STEMI Teamwork: Learning from Simulation
Chairperson: William Hamman, MD
Panelists: Eva Kline-Rogers, RN, J. Brent Myers, MD, Xavier Anton, MD, Jose Marquez, MD, Thomas Alexander, MD
Dr. William Hamman is a commercial pilot, cardiologist and systems expert who has done innovative work using simulative techniques to improve patient safety and process efficiency for numerous medical specialties and procedures. His pioneering work has particular significance for STEMI interventions; it is the recipient of numerous grants and comprised of ACC initiatives regarding the role of medical simulation. In this remarkable workshop, Dr. Hamman will demonstrate, via the use of myriad simulation techniques, the vital importance of teamwork for successful D2B interventions. The entire STEMI intervention is simulated, and the critical interplay of the EMS, ED and EMS personnel is revealed. Through this workshop, attendees will be able to identify the system deficiencies and learn from world experts some pragmatic ways to improve their respective STEMI programs.
Target audience – interventional cardiologists, ED physicians, CVLand EMS personnel, hospital administrators, healthcare payers, press, general attendees.
Recommended reading from the speaker
Workshop 9 – STEMI Interventions CINE Review
Chairperson: Sameer Mehta, MD
Panelists: Ralph Nader, MD, Vinod Jorapur, MD, Faisal Shamshad, MD, Rosanna Briceño, MD
In this interactive workshop, LUMEN Course Director Dr. Sameer Mehta will use a compendium of cineangiograms to teach practical tips for performing STEMI interventions. Up to 20 selected cases will be demonstrated, ranging from the simple STEMI intervention to more complex D2B procedures. Emphasis will be placed on the use of standardized techniques for STEMI intervention, practical tips of lowering D2B times, selection of PCI hardware, and a review of thrombectomy devices and techniques. The critical issues of identifying the culprit STEMI lesion and effective strategies of STEMI interventions using the thrombus grade for compulsive management of thrombus will be discussed. Other practical lessons learned from the SINCERE database will also be reviewed.
Target audience – interventional cardiologists, fellows-in-training, CVRT, nurses.
Recommended reading from the speaker

4:30-6:00 p.m. STEMI Workshops D (CHOOSE ONE)

Workshop 10 – Cooling/Hypothermia Devices
Chairperson: Michael Mooney, MD
Panelists: Barbara Unger, RN, Dean Kereiakes, MD, Cindy Grines, MD, Faisal Shamshad, MD, Luis Correa, MD
Hypothermia is emerging as a viable modality for improving the survival of cardiac arrest patients as well as a subset of patients with STEMI interventions (less conclusive data). Numerous new protocols and hypothermia devices are being used to cool the affected patient. In addition to being a world-class STEMI regional center, Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis, MN, is emerging as a top center with expertise in hypothermia protocols. Dr. Michael Mooney from this institution will moderate this innovative workshop along with an expert panel.
Target audience – interventional cardiologists, ED physicians, CVL and EMS personnel, hospital adminstrators, healthcare payers, press, general attendees.
Recommended reading from the speaker
Workshop 11 – Demonstrations of Pre-Hospital EKG Systems
Chairperson: James Hoekstra, MD
Panelists: J. Brent Myers, MD, Ralph Nader, MD, Vinod Jorapur, MD, Nizme Meza-Ruiz, MD
Early diagnosis of STEMI can be moved to the prehospital environment, as has been demonstrated at numerous European and North American centers. The rapid acquisition of the 12-lead EKG, its transmission and precise interpretation, begin the appropriate management of a STEMI process that will successfully lead to predictable D2B times of <90 minutes, as recommended by the guidelines. This vital prehospital work also leads to early STEMI activation and appropriate triage of the patient with effective bypass strategies to STEMI receiving facilities. Several innovative prehospital EKG systems are presently available, and this LUMEN workshop is dedicated to educating attendees about these various options. An experienced panel, comprised of EMS and ED experts and interventional cardiologists, will conduct this workshop.
Target audience – EMS, ED and CVL staff, interventional cardiologists, fellowsin-
training, nurses, administrators, payers.
Recommended reading from the speaker
Workshop 12 – Tips for Setting up a Transfer Network
Chairperson: Ivan Rokos, MD
Panelists: Barbara Unger, RN, Michel Le May, MD, Charanjit Rihal, MD, Sameer Mehta, MD
A key ingredient for the success of a STEMI network is seamless transfer of a STEMI patient to a STEMI receiving center. This process can become enmeshed in a multitude of financial, logistic and legal barriers, and it takes more than charisma to deal with these tricky issues! However, a matter of such critical importance is paramount to the success of a STEMI network, and we, at LUMEN, are able to recommend some of the world’s best STEMI transfer networks and offer their expertise to the LUMEN audience. In the workshop, Ivan Rokos, MD and a team of global STEMI experts provide pragmatic tips for setting up a STEMI transfer network.
Target audience – interventional cardiologists, EMS and ED personnel, nurses, administrator payers.
Recommended reading from the speaker

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