Asian Cardiovasc Thorac Ann 1999;7:1-2
© 1999 Asia Publishing EXchange Pte Ltd
The Emergence of Coronary Intervention in the Asian-Pacific Region
Lim Yean Leng, AM
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National Heart Centre Republic of Singapore
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The prevalence of coronary artery disease in developing countries in Asia is thought to be lower than in developed countries in the West. The treatment of coronary artery disease also lags behind that in developed countries for economic and technical reasons. With economic prosperity and its associated improvement in technical development and lifestyle, the incidence and management of coronary artery disease have also undergone significant changes in many Asian and Pacific countries in the past decade. Cardiovascular disease remains the most common cause of mortality in these Asian-Pacific nations and coronary mortality accounts for a majority of the deaths.
With the exception of Australia and New Zealand in the Asian-Pacific region, progression of coronary disease treatment, either by surgical revascularization or coronary intervention, has been slower in the region compared to the West. The lack of adequate physical facilities and qualified manpower are the obvious reasons for this discrepancy. Government priorities in planning healthcare budgets and consumer affordability of often expensive ‘high-tech’ treatments are other limiting factors to the growth of modern coronary artery disease treatment in certain Asian countries, in particular the populous nations such as China and India. Cultural differences, such as aversion to surgical invasion of the body, definitely impede the progress of effective surgical therapy for coronary artery disease in numerous Asian cultures. This is evident from the disproportionately low incidence of coronary artery bypass surgery in Japan compared to the very active and excellent angioplasty programs.
Until very recently, the "Asian economic miracle" was transforming a group of developing countries in Asia into growth nations. Economic prosperity demands com-mensurate improvement in healthcare standards for foreign investment to continue. This has stimulated Government initiatives, resulting in a spate of building and renovation projects for hospitals and specialist centers in Asia. The influx of Western medical teams and the training of Asian specialists in the West have provided the necessary ingredients for the increased number of heart centers and cardiovascular institutes in many countries. The near completion of the first Western-style Xiamen University Medical College and its affiliated Cardiovascular Institute in China is one such example.
The growth of coronary intervention in China and India has gathered momentum in the last five years. Sufficient technological advances in terms of trained personnel and catheter laboratories have annually enabled the doubling of cases of coronary intervention performed in these two populous countries. Many new cardiovascular intervention units have also been established in Hong Kong, Malaysia, Thailand, Korea, and Taiwan. Japan currently has in excess of 600 cardiac catheter laboratories.
These simultaneous activities are essential for the formation of the embryonic "Asian-Pacific bloc" for coronary intervention to complement the existing mature "European and North American blocs". Australia and New Zealand, with their advanced technology and medical know-how, have been crucial factors in the emergence of the "Asian-Pacific bloc" of interventional cardiology, including both surgical and medical interventions.
The Asian-Pacific Society of Cardiology has been in existence since 1960. It holds a scientific meeting every four years. This has been the main meeting venue for cardiologists and surgeons throughout the region, including countries of the Middle East. The Asian-Pacific Society of Interventional Cardiology (APSIC) was formed in Singapore in 1990 and formally constituted as an independent body in 1998. The first live demonstration course in coronary intervention in Asia occurred in Singapore in 1989. Since then, many excellent live demonstration courses have evolved, including annual regional courses in Japan, China, India, Korea, Taiwan, and Hong Kong. This year, satellite linkage of the National Heart Centre of Singapore and the Australia and New Zealand Cardiac Society interventional cardiology live demonstration took place with transmission of live cases from Perth, Australia to Singapore and vice versa. Following this initial success, the National Heart Centre in Singapore held a joint meeting with the Washington Transcatheter Therapeutic Conference in January 1999. In May this year, Australia, China, India, Japan, Korea, New Zealand, and Singapore will contribute an Asian-Pacific segment with live cases transmitted to Paris via satellite for the 10th Endovascular Therapy Course Conference, May 18–21, 1999. This is a significant step towards the globalization of cardiovascular intervention.
Australia has been a leader in coronary artery disease treatment in the Asian-Pacific region for the past two decades. It has been the training ground for many of the current leading heart specialists in Asia. Its geographic proximity and recent political and economic alliance with the region have been key factors in the successful formation of a strong Asian-Pacific coronary intervention bloc. Joining the forces of the Australian and New Zealand centers with those of Asian regional centers has produced a credible group of experts who are recognized by their peers in the West. The support of world-renowned centers in England, Europe, America, and Canada in terms of education and training, has been crucial in the evolution of the Asian-Pacific bloc for coronary intervention.
Interventional cardiology, more generally cardiovascular intervention, has entered a very exciting growth phase in Asia. The emergence of this Asian-Pacific bloc adds significantly to the globalization of interventional cardiology. This can only benefit patients afflicted with coronary heart disease in this region through the sharing of knowledge and skill by the more advanced Western nations. The Asian-Pacific Society of Cardiology must capitalize on this collaboration of the East and the West to achieve optimal scientific advancement in the treatment of coronary artery disease.
