Francisco Fernández-Avilés, MD, PhD, FESC, FACC - Circulation

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Circulation June 9, 2009 On other pages... European Perspectives in Cardiology Spotlight: Francisco Fernández-Avilés, MD, PhD, FESC, FACC Leading Translational Research With Stem Cells to Prevent and Treat Postinfarction Heart Failure Francisco Fernández-Avilés, chair of the Department of Cardiology, University Hospital Gregorio Marañón, Madrid, Spain, talks to Barry Shurlock, MA, PhD. The Department of Cardiology at the University Hospital Gregorio Marañón, Madrid, Spain, is the largest heart centre in Spain, and it plays a leading role in the studies of stem cell techniques for repairing heart tissue. Like other cardiology departments in Spain, it sends its experienced cardiologists to business school but still puts the patient at the centre, according to Fernández-Avilés, MD, PhD, FESC, FACC, chief and professor of medicine at Complutense University, Madrid, Spain. “I Decided to be a Doctor Before I Was 10 Years Old Because I Had the Experience of Seeing Close Relatives Who Were Sick” Professor Fernández-Avilés was born in Cuenca, Spain, about 50 miles (80 kilometres) from Madrid. Cuenca is a small historic town that is now a World Heritage Site and a tourist destination. His father died when he was very young, and his mother took him to live in Madrid, which almost makes him a “Madrileño.” He says, “I decided to be a doctor before I was 10 years old because I had the experience of seeing close relatives who were sick and I considered the work of medicine to be marvellous. I was the first to go to university. It was fantastic! I was very, very lucky.” He studied medicine at Complutense University and the University Hospital Gregorio Marañón. Complutense University is widely regarded as the premier university in Spain. First founded as a studium generale by a Castilian monarch at the end of the 13th century (1293), it was refounded by papal edict in the early 16th century (papal bull 1499, opened 1509). In 1836, it moved to central Madrid. Among its famous sons are Santiago Ramón y Cajal, MD (1852–1934), who won a Nobel Prize in 1906 for his work on the fine structure of the nervous system and gave his name to Cajal cells. His name is commemorated in a city centre hospital in Madrid. He also made many contributions to tumour biology, although they are little known to non- Spanish speakers. More recently, in 1959, the Nobel Prize for Medicine was shared by the Spanish physician and biochemist Severo Ochoa, MD (1905–1993). Ochoa studied in Madrid and worked in several cities in Germany and the United Kingdom before emigrating to the United States, where he studied the enzymatic mechanisms of oxidative metabolism and helped to unravel the biological synthesis of RNA and DNA. By 1990, Professor Fernández-Avilés had performed more than 1000 angioplasties and overseen 50 cases as the Centre of Excellence: Department of Cardiology, University Hospital Gregorio Marañón, Madrid, Spain Francisco Fernández-Avilés, MD, PhD, FESC, FACC, chair of the Department of Cardiology, University Hospital Gregorio Marañón, Madrid, Spain, describes the Department and its ambitious research programme with a budget of $6 million and major research projects on heart failure, coronary syndromes, cardiac valve disease, cardiovascular imaging, arrhythmias, and stem cell therapy. Page f131 Downloaded from http://circ.ahajournals.org/ by guest on December 2, 2012 f127 Circulation: European Perspectives
f128 Circulation: European Perspectives Circulation June 9, 2009 Aerial view of the University Hospital Gregorio Marañón, Madrid, Spain, where Professor Fernández-Avilés is chair of the Department of Cardiology. The hospital is named after the celebrated endocrinologist, Gregorio Marañón y Posadillo, MD (1887–1960), a writer, philosopher, and brilliant all-round intellectual. Photograph courtesy of Professor Fernández-Avilés. coordinator of the heart transplantation programme. In that year, at the relatively young age of 37, he was appointed to head the Department of Cardiology at the University Hospital, Valladolid, Spain, a city of half a million people and about 130 miles (200 kilometres) north of the Spanish capital. Once favoured by the Spanish court and containing one of the houses where Cervantes, the author of Don Quixote, lived, it is now the economic hub of its region and a venue for a prestigious international film festival. At the University Hospital, Valladolid, Professor Fernández-Avilés, while running his own department, was able to spread his wings and pursue influential studies of poststent restenosis and postinfarct reperfusion in general. A key platform for his work was the Institute of Heart Sciences [Instituto de Ciencias del Corazon] at Valladolid, which he created in 1998 and directed until 2006 when he took up his present appointments in Madrid. He has 160 articles in peer-reviewed journals and, from a long list of prizes, is particularly proud of the Order of Merit in Civil Health [Orden del Mérito Civil en Sanidad], the highest award of its kind in Spain, presented to him in 2004 by the Spanish Minister of Health. “Every Year in the Last 5 Years, We Have Sent About 12 to 15 Cardiologists Around the Age of 40 to the Escuela Superior de Administración y Dirección de Empresas Business School in Madrid” In the early 1990s, Professor Fernández-Avilés started to win awards at the annual meetings of the Spanish Society of Cardiology—for example, “Best Abstract of the Year,” “Young Investigator Award,” and “Best Original Article” in the prestigious Revista Española de Cardiologia, the official Spanish Society of Cardiology journal, of which he was editor-in-chief for 6 years (from 1991 to 1997). In 1993, he made an unusual choice for a cardiologist—for 1 week every month, he flew off to Barcelona to attend courses at the Escuela de Alta Dirección y Administración Business School to obtain a diploma in the Direction and Management of Medical Departments. He comments, “I needed it! Now the Novartis Cardiovascular Institute and the Foundation Miguel Servet (named after a Spaniard who described pulmonary circulation before William Harvey), with the advice of chiefs of the most prestigious cardiology departments in Spain, have decided to promote the teaching of business skills for cardiologists. Every year in the last 5 years, we have sent about 12 to 15 cardiologists (from throughout Spain) around the age of 40 to the Escuela Superior de Administración y Dirección de Empresas Business School in Madrid. When we started, there were many negative answers from all the potential candidates, and we had to work hard to convince them to attend. Now there is a waiting list—we get about 50 applications each year!” “More Than 70% of Patients in the World Do �ot Have Access to Primary Percutaneous Coronary Intervention” One of the most enduring legacies of Professor Fernández- Avilés’ period in Valladolid is the multicentre Spanish study group, Group for the Analysis of Acute Ischemic Heart Disease [Grupo de Análisis de la Cardiopatía Isquémica Aguda] (GRACIA), 1,2 which he founded in 1999. GRACIA has made major contributions to postinfarct reperfusion by piecing together the optimal strategy for the key therapeutic elements—thrombolysis, angiography, angioplasty, primary percutaneous coronary intervention (PCI), facilitated stenting (with thrombolysis with tenectplase and enoxaparin and thienopiridines), and conservative management. The outcomes of the GRACIA-1 trial, 1 published in the Lancet in 2004, and other data made it necessary to rewrite the European Society of Cardiology (ESC) guidelines for PCI, which were published in the European Heart Journal in 2005. 3,4 According to Professor Fernández-Avilés, “More than 70% of patients in the world do not have access to primary PCI. If primary angioplasty cannot be done, postthrombolysis PCI is mandatory. The logistics of acute myocardial infarction (AMI) therapy with PCI is being further studied with GRACIA-3, which is now complete and has compared restenosis with a paclitaxel-eluting stent versus a bare stent; it has also determined the effect of the antiplatelet agent, tirofiban, administered before PCI but after thrombolysis.” GRACIA-4 will study what Professor Fernández-Avilés calls “the following day strategy” or “rescue PCI” in cases without evidence of reperfusion after lysis. “In 2001, I Founded the Terapia Celular Aplicada al Miocardio Group to Develop Translational Research With Stem Cells to Prevent and Treat Postinfarction Heart Failure” Professor Fernández-Avilés’ experimental and clinical studies on ischaemia and reperfusion now span more than 25 years. For much of that time, he has sought to reduce mortality after myocardial infarction by what he calls (in an article presented at the ESC Congress in 2005) “definitive Downloaded from http://circ.ahajournals.org/ by guest on December 2, 2012
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Francisco Fernández-Avilés, MD, PhD, FESC, FACC - Circulation

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