5 Questions with Dr. Bhatt

A Conversation With Shamir R. Mehta, MD, MSc, FRCPC, FACC, FESC

For this issue, Dr. Bhatt talks with Shamir R. Mehta, MD, MSc, FRCPC, FACC, FESC, professor of medicine at McMaster University in Hamilton, Ontario, Canada; director of the interventional cardiology program at Hamilton Health Sciences; senior scientist at the Population Health Research Institute; and a member of the Cardiology Today’s Intervention Editorial Board.

Mehta completed his residency training at St. Michael’s Hospital and interventional cardiology fellowship at University Health Network in Toronto. At the end of his clinical training, he also completed a research fellowship at McMaster University before becoming a faculty member.

Named one of Canada’s “Top 40 Under 40” in 2004, Mehta is now a distinguished clinician and researcher who performs hundreds of interventional procedures each year and has received investigator awards and grants from the Canadian Institutes of Health Research.

What area of research in intervention most interests you right now and why?

Dr. Mehta: I have always been interested in large pragmatic trials of strategies. Individual drug trials evaluating specific treatments are important and help us advance the field, but I’m most intrigued by studies involving strategies that we use every day, such as the question of complete revascularization vs. performing PCI only on the culprit lesion or identifying the optimal time to intervene in a patient with ACS.

Deepak L. Bhatt

However, these trials are difficult to perform because they are rarely funded by industry. You must also have the ability to change what people inherently believe is the right strategy and challenge that to some extent. Nevertheless, these studies are worthwhile and very satisfying once they’re completed.

Additionally, particularly because I do mitral valve interventions, I’m interested in the whole area of structural heart disease and how that field can move forward. Previously, this area fell in the domain of surgeons. As interventional cardiologists, part of our culture and who we are is having large randomized controlled trials to evaluate almost everything we do, whereas that previously did not exist to the same extent in the surgical literature. Consequently, when we started performing mitral valve interventions and looked back at the evidence for treating mitral regurgitation, such as repairing and replacing valves, we found it was not that strong. I think over the next 10 years, interventional cardiologists are going to leave their thumbprint on this area in a major way.

What was the defining moment that led you to your field?

Dr. Mehta: When I completed my clinical training in 1997, my main focus was working as an interventional cardiologist.

At the time, my plan was to do a 1-year master’s program. When I arrived at McMaster University, however, a whole new world opened up to me. I worked with Salim Yusuf, MD, DPhil, to design a randomized trial involving clopidogrel — a drug that few people had heard of at the time. I knew nothing about clinical research at that point, but I started working on that study with my colleagues and learning about this whole world of clinical research, which was a defining moment for me.

What advice would you offer a student in medical school today?

Dr. Mehta: My niece started her first year of medical school in the fall. I told her that a whole new world is going to open up to her. She is going to learn things that she probably never thought she would learn and see things that are absolutely incredible. I told her to remember, however, that as she moves forward, it is important to pay attention to her own well-being by making sure that she stays healthy by exercising, eating well and maintaining relationships with her family and friends to keep her grounded because those years can be overwhelming.

Shamir R. Mehta

Also, it’s important to have balance in life, and it’s important to learn to have that balance early on. All of these students entering medical school are bright and motivated, but maintaining balance is essential. I wish I had learned that earlier in medical school.

Have you ever been fortunate enough to be witness or have been a part of medical history in the making?

Dr. Mehta: I was fortunate to have been involved with the CURE trial — one of the key trials of P2Y12 inhibitors. I worked on this trial in the late 1990s, and the study, which was published in 2001, unequivocally showed the benefit of adding a P2Y12 inhibitor to aspirin. This changed the whole landscape of how we treat ACS — of how patients are managed — and improved outcomes to a large extent.

What are your hobbies outside of practicing medicine?

Dr. Mehta: I enjoy endurance sports, including long-distance running and endurance cycling. I’ve completed four full marathons, many half marathons and am considering training for an ultramarathon this fall and winter. I run about four or five times per week and cycle at least once or twice per week.

Because my schedule can be fairly busy, I also enjoy involving my 10-year-old twins by having them bike with me while I’m running, particularly in the evenings, so we can spend more time together. – by Melissa Foster

For this issue, Dr. Bhatt talks with Shamir R. Mehta, MD, MSc, FRCPC, FACC, FESC, professor of medicine at McMaster University in Hamilton, Ontario, Canada; director of the interventional cardiology program at Hamilton Health Sciences; senior scientist at the Population Health Research Institute; and a member of the Cardiology Today’s Intervention Editorial Board.

Mehta completed his residency training at St. Michael’s Hospital and interventional cardiology fellowship at University Health Network in Toronto. At the end of his clinical training, he also completed a research fellowship at McMaster University before becoming a faculty member.

Named one of Canada’s “Top 40 Under 40” in 2004, Mehta is now a distinguished clinician and researcher who performs hundreds of interventional procedures each year and has received investigator awards and grants from the Canadian Institutes of Health Research.

What area of research in intervention most interests you right now and why?

Dr. Mehta: I have always been interested in large pragmatic trials of strategies. Individual drug trials evaluating specific treatments are important and help us advance the field, but I’m most intrigued by studies involving strategies that we use every day, such as the question of complete revascularization vs. performing PCI only on the culprit lesion or identifying the optimal time to intervene in a patient with ACS.

Deepak L. Bhatt

However, these trials are difficult to perform because they are rarely funded by industry. You must also have the ability to change what people inherently believe is the right strategy and challenge that to some extent. Nevertheless, these studies are worthwhile and very satisfying once they’re completed.

Additionally, particularly because I do mitral valve interventions, I’m interested in the whole area of structural heart disease and how that field can move forward. Previously, this area fell in the domain of surgeons. As interventional cardiologists, part of our culture and who we are is having large randomized controlled trials to evaluate almost everything we do, whereas that previously did not exist to the same extent in the surgical literature. Consequently, when we started performing mitral valve interventions and looked back at the evidence for treating mitral regurgitation, such as repairing and replacing valves, we found it was not that strong. I think over the next 10 years, interventional cardiologists are going to leave their thumbprint on this area in a major way.

What was the defining moment that led you to your field?

Dr. Mehta: When I completed my clinical training in 1997, my main focus was working as an interventional cardiologist.

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At the time, my plan was to do a 1-year master’s program. When I arrived at McMaster University, however, a whole new world opened up to me. I worked with Salim Yusuf, MD, DPhil, to design a randomized trial involving clopidogrel — a drug that few people had heard of at the time. I knew nothing about clinical research at that point, but I started working on that study with my colleagues and learning about this whole world of clinical research, which was a defining moment for me.

What advice would you offer a student in medical school today?

Dr. Mehta: My niece started her first year of medical school in the fall. I told her that a whole new world is going to open up to her. She is going to learn things that she probably never thought she would learn and see things that are absolutely incredible. I told her to remember, however, that as she moves forward, it is important to pay attention to her own well-being by making sure that she stays healthy by exercising, eating well and maintaining relationships with her family and friends to keep her grounded because those years can be overwhelming.

Shamir R. Mehta

Also, it’s important to have balance in life, and it’s important to learn to have that balance early on. All of these students entering medical school are bright and motivated, but maintaining balance is essential. I wish I had learned that earlier in medical school.

Have you ever been fortunate enough to be witness or have been a part of medical history in the making?

Dr. Mehta: I was fortunate to have been involved with the CURE trial — one of the key trials of P2Y12 inhibitors. I worked on this trial in the late 1990s, and the study, which was published in 2001, unequivocally showed the benefit of adding a P2Y12 inhibitor to aspirin. This changed the whole landscape of how we treat ACS — of how patients are managed — and improved outcomes to a large extent.

What are your hobbies outside of practicing medicine?

Dr. Mehta: I enjoy endurance sports, including long-distance running and endurance cycling. I’ve completed four full marathons, many half marathons and am considering training for an ultramarathon this fall and winter. I run about four or five times per week and cycle at least once or twice per week.

Because my schedule can be fairly busy, I also enjoy involving my 10-year-old twins by having them bike with me while I’m running, particularly in the evenings, so we can spend more time together. – by Melissa Foster

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