A Destination for Cardiac Interventional Care
Quad Citians don't need to go far to find one of the largest and most advanced cardiac interventional programs in the nation.
The Genesis Cardiac Catheterization program gives nationally recognized quality care, with excellent outcomes. It responds to life-threatening heart attacks far faster than the national standard of care. Through research and innovation, it offers patients new and cutting-edge procedures and technology sooner than many other heart centers.
As a result, the Genesis Heart Institute has emerged as a regional "destination" and center of excellence for interventional heart care.
Indeed, Genesis Medical Center, Davenport’s ranking as one of the nation’s “Top 50 Heart Hospitals” in 2011 was due in no small part to the skill of the dedicated cardiac interventionalist partners at Genesis and Cardiovascular Medicine, P.C
“People may ask, ‘How can a region the size of the Quad Cities have one of the largest cardiac catheterization programs in the U.S.?’ Well, when patients come to our group of skilled cardiologists and a hospital like Genesis, they receive the efforts of a whole team of experts with many, many years of experience,” said Edmund Coyne, M.D., president of Cardiovascular Medicine (CV Med.) and board chairman of the Genesis Heart Institute.
“What does that experience mean? Because of the scale and quality of our program, it means we’re capable of doing things that those who are newer to the field might find challenging.”
Big things come in small packages
The cardiac interventional program has grown significantly over the years through referrals, yet has remained located in a relatively small community. As a result, a larger percentage of the program’s admissions come from outside Davenport and the Quad Cities. Patients are often referred because of the complexity of their condition, such as when surgery is not an option.
“We’re a premier program because we offer what patients want most -- choice, innovation and superior outcomes,” Dr. Coyne said.
Among the program’s skilled interventional cardiologists is Jon Robken, M.D., who specializes in percutaneous coronary interventions, or PCI. Commonly known as angioplasty, PCI is a non-surgical procedure used to treat the narrowed arteries of the heart. This is due to the buildup of the cholesterol-laden plaques that form from a common disease called atherosclerosis.
“Genesis and CV Med have great pride in our program,” Dr. Robken said. “It has been a work in progress for 30 years. We’ve been with this treatment format since the initiation of angioplasty and stents. We were one of the first centers to work with drug-eluting stents, and now, we’re leading the way yet again by participating in a clinical trial for the use of bio-absorbable “scaffolds” in the artery that eventually completely disappear. We’ve worked very diligently to be as good of a program as you can get anywhere in the country.”
During PCI, a cardiologist feeds a deflated balloon on a catheter that travels up through blood vessels to reach the heart blockage. The balloon is inflated to open the artery, allowing blood to flow. A stent, or tiny metal coil, is often placed at the site to keep the artery open.
Dr. Robken has seen the evolution of stents over the years and been involved in various clinical trials. Genesis, Davenport did about 1,700 PCIs in 2013. “The stents that are coated with medication to prevent scar tissue and the re-narrowing process continue to get better,” he said. “But nevertheless, a bare metal stent is there forever.”
Stents of the future
He’s excited Genesis is the only hospital in Iowa and the region participating in a nationwide study of dissolvable stents to open heart arteries. Unlike wire stents that remain in the vessel, the re-absorbable ones are coated with an immunosuppressant drug to prevent re-narrowing of the artery and disappear within 2 1/2 years.
“The response of the artery has been a grand surprise to all of us -- it returns to normal in that segment,” Dr. Robken said of the study. “The plaque and the disease process re-absorb. New tissue grows in and returns to normal function. The current trials are still considered investigational, but I expect the results will revolutionize how we treat our coronary intervention patients.”
Atherosclerosis can develop to such a level that bypass surgery is not an option; the arteries are not strong enough to bypass or they have too much plaque in too many locations.
“We have many patients who already have had one or two open-heart procedures and another surgery is not an option for them,” Dr. Robken said. “And we have patients who have been referred for surgery but have been declined because of weakness of the heart, advanced lung disease or other conditions that make them a very high risk for surgery.”
Low re-admission rate
In 2013, Genesis was among 13 of 300 hospitals reporting to an American College of Cardiology registry whose hospital readmission rates following PCI were lower than the national average.
“Our goal is to get it right the first time to avoid re-admissions, which are neither good for the patient nor costeffective,” Dr. Coyne said.
Dr. Robken added, “We do complex, technically challenging, difficult, and long coronary interventions. Despite that, we have a very low chance of patients returning to the hospital in the first month.”
There are three ways to treat heart artery blockages -- with medication, bypass surgery, and PCI.
“Most of the blockages are treated with medication only,” said Dr. Coyne, stressing that cardiologists weigh many factors, such as age and location and extent of the blockage, before determining the best intervention.
“There are times when we know medication is going to be insufficient and bypass surgery isn’t warranted, and that’s when we stent the artery.”
CV Med and Genesis physicians offer cardiac patients a full spectrum of cardiac treatment options, such as medication, catheterization or PCI, electrophysiology, and surgery, including the new minimally invasive procedures.
Meanwhile, as the incidence of coronary artery disease decreases -- thanks in part to improved cholesterol-lowering medications and fewer smokers -- new challenges have come to the forefront.
“Now we face new epidemics like atrial fibrillation and congestive heart failure,” Dr. Coyne concluded. “Our institution has to be prepared, and we are prepared to handle those epidemics.”