A/Prof Koh Tian Hai

Course Director, 12^th Singapore LIVE Course

A/Prof Lim Yean Teng, Dr Terrance Chua and Dr Tan Bien-Soo

Co-Directors, 12^th Singapore LIVE Course

Colleagues

Distinguished guests

Ladies and gentlemen

It gives me great pleasure to officiate at the opening of the 12^th Singapore Live Interventions in Vascular Endotherapy (LIVE) Course, organised by the Singapore National Heart Centre, with the participation of the Euro Paris Course on Revascularisation, and centres in Thailand and Australia. To our overseas delegates and faculty, welcome to Singapore!

I am happy to note that, since its inception more than a decade ago, the Singapore LIVE course has become an important interventional meeting in the Asia-Pacific region. The last course saw a record turnout of more than 900 participants from Asia, and especially from the ASEAN countries. Despite the current economic downturn, it is heartening to see so many of you here today. I understand from the organisers that there are about 700 participants this year.

Rapid advances in medical technology have led to more and more procedures and techniques being conceived, tested and made available for clinical practice in Cardiology. Drug-coated coronary stents and endovascular aortic stent grafts are examples of advanced interventional technologies which are now available to patients.

This year’s Singapore LIVE course will highlight the expanded applicability of drug-coated coronary stents for longer lesions, smaller vessels, as well as for diabetics.

The late Dr. Andreas Greuntzig, the inventor of percutaneous transluminal coronary angioplasty (or PTCA), had commented that if it were not for the problem of re-stenosis, angioplasty would have been the perfect treatment for obstructive coronary artery disease. After more than two decades, the advent of drug-coated stents signifies another stage in our progress towards this goal.

Two large clinical trials, SIRIUS and TAXUS II trials, have shown substantial reductions in re-stenosis rates with Sirolimus-coated and Paclitaxel-coated stents, compared with conventional bare-metal stents. Such stents, when used appropriately, therefore hold good promise for patients with coronary artery disease.

Endovascular aortic stent grafting will also be featured in this year’s course. This minimally invasive technique has allowed the treatment of potentially life-threatening aortic aneurysms with lowered surgical risks to patients. Compared to patients treated with conventional open surgery, patients undergoing endovascular aortic stent grafting are hospitalised for a much shorter period of only 2-3 days and rarely require intensive care. The introduction of this new technique is extremely beneficial to patients with aortic aneurysms which are amenable to treatment in this way, as they are often elderly and have a significant morbidity rate of 15-30% with open surgery.

However, such advanced medical technologies come with hefty price tags. For example, aortic stent graft costs between S$12,000 and S$18,000. In the year 2000, the Ministry of Health in Singapore established a Health Services Development Programme to evaluate the cost-effectiveness of new medical capabilities and health services in the public healthcare system, through the funding of advanced medical technologies and treatments on a pilot-basis. Through this programme, the Ministry of Health currently provides subsidies for aortic stent grafts for financially-needy patients for whom the grafts are medically indicated and technically feasible.

Whilst new and advanced medical interventions offer better clinical outcomes and have given many patients a new lease of life, prevention is always better than cure. We must never underestimate the value of a healthy lifestyle. Regular exercise, healthy eating, stress reduction and avoidance of cigarette smoking can reduce our risk for coronary heart disease. The primary prevention of heart disease and its antecedent risk factors can reduce the incidence of coronary artery disease and the need for complex and expensive treatments.

Coronary heart disease and other heart diseases remain a major cause of death in Singapore and other developed countries. Last year, they accounted for more than a quarter of all deaths in Singapore. The Ministry of Health in Singapore has developed and implemented several strategies to prevent and control coronary heart disease, through the reduction of and early screening for major risk factors, optimal control of diabetes, hypertension and hyperlipidaemia as primary and secondary prevention of coronary heart disease. Through this multi-pronged approach, it is hoped that by 2010, premature mortality from coronary heart disease in those aged 35-64 years would be reduced by 30%, from a baseline of 67 deaths per 100,000 in 1997.

In conclusion, a coordinated and concerted effort, and multi-disciplinary approach are necessary for the effective prevention and management of heart and vascular diseases. All of us here this morning have an important role to play in reducing the burden of these diseases.

The 12^th Singapore LIVE offers an excellent opportunity for medical and paramedical professionals in various disciplines including cardiology, radiology and vascular surgery, to exchange information and share experiences. I would like to take the opportunity to congratulate the organising committee for putting together a very comprehensive and interesting programme. I am sure the participants will benefit greatly from the learning experience.

I wish you a fruitful and successful meeting. It is now my pleasure to declare the 12^th Singapore LIVE course open.

Thank you.

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