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In This Issue:
Braunwald, Cannon & Wiviott Reveal the Scientific and Professional Bonuses of TIMI
Twenty years ago, Dr. Eugene Braunwald had a vision. At the time, he was midway through his 24-year stint as chairman of the BWH Department of Medicine and he wanted to identify the best clot-busting drug for heart attack patients in order to reduce mortality from this all too common condition. In 1984, that vision became a reality when BWH launched a series of national clinical studies known today as the Thrombolysis in Myocardial Infarction (TIMI) trials. Not only have these trials revolutionized patient care, they have also helped cultivate a unique research environment at BWH.
“When the first TIMI trial began, we had no plan to conduct additional studies,” said Braunwald, chairman of the TIMI Study Group. “But it went extremely well, and with the infrastructure already in place, it just made sense to continue because there were many additional pressing questions to be answered.”
What began as a single trial of 316 patients across 13 academic medical centers in the United States, has since expanded to include 32 completed TIMI trials involving more than 60,000 patients across 800 hospitals in 50 countries, with 12 additional studies that are in various stages of ongoing activity today. All together, nearly 50 full-time researchers and staff are involved in TIMI trials today at BWH.
Over the past two decades, the TIMI trials have provided significant insight into the treatment of patients who suffer from acute myocardial infarction (MI) and unstable angina. “We’ve seen mortality from heart attacks reduced almost in half over the last 20 years, and the TIMI trials have contributed to this improvement,” said Braunwald.Cultivating Mentors and OpportunitySince the beginning, TIMI has also offered the unique opportunity for investigators at all levels to get their feet wet in compelling clinical research. From co-investigators, to principal investigators to study leaders, TIMI also provides opportunities for professional growth, as investigators develop their research careers.
Braunwald and Carolyn McCabe comprise the first generation of TIMI investigators, having been a part of TIMI since its inception. Braunwald acted as principal investigator for the TIMI 1 trial and has since transitioned into the role of chair for the TIMI Study Group, making TIMI his full-time job, after serving as Chief Academic Officer at Partners. McCabe, who served as co-principal investigator, along with Braunwald, for TIMI 2, now serves as project director for all of the trials.
Among the next generation of TIMI investigators at BWH are Drs. Elliott Antman, director of the Levine Cardiac Care Unit, and Dr. Christopher Cannon. Cannon first became involved in the TIMI trials as a cardiology fellow at BWH in 1990. “I had read an editorial written by Dr. Braunwald regarding the classification of patients with acute coronary syndromes, and as a result, I began using the method he described during my cardiology rotation fellowship,” said Cannon. “Soon thereafter, Dr. Braunwald approached me to become involved in TIMI 3.”
After contributing to TIMI 3, Cannon became the principal investigator for TIMI 4 and has since served in the same capacity for nine TIMI trials. Cannon joins several other physicians and associate physicians, who comprise the full principal investigator pool, overseeing the ongoing TIMI trials at BWH today.
“What really sets the BWH TIMI Study Group apart from the rest is the overall research culture of the hospital,” said Cannon. “BWH consistently supports research, granting ‘protected time’ when investigators are not on clinical service and can shift their efforts to scientific investigation. This culture is imperative to facilitate the proper training, to design studies, to enroll patients and to accomplish all the other aspects of producing a high quality trial. BWH makes that happen. Plus, the overall strengths in all aspects of cardiology at BWH are critical.”
The Next GenerationRounding out the third generation of TIMI investigators is Dr. Stephen Wiviott, a cardiology fellow at BWH. Wiviott completed his medical residency at BWH, and subsequently returned to serve as chief medical resident. “As a trainee at BWH, I was taught to look at the evidence basis for my decisions—to look at not only the clinical grounds but also the scientific research,” he said, explaining that this “evidence-based” approach was one of the reasons he chose to pursue fellowship training in Cardiology. “What I came to realize is that a lot of the information that guides our decisions comes out of clinical trials.”
As Wiviott began to contemplate the research aspect of his fellowship training, he immediately thought of TIMI. He approached Braunwald about the possibility of becoming involved in the trials as a Cardiology research fellow at BWH. Wiviott has since contributed to TIMI as a co-investigator for the final two years of his fellowship and will continue to do so when he assumes the role of junior faculty member this summer.
“I really could not have had this experience anywhere else in the world,” said Wiviott. “I’ve been able to work very closely with senior investigators and to play an important role in trials from the onset. The amount of time the senior investigators spend teaching and mentoring the junior members of the team is truly amazing. I hope to someday have the opportunity to lead a TIMI trial and to continue to pass on the wonderful training I have attained from BWH’s talented faculty,” he added.