Professor James Spratt:
Thanks for having me. Sounds like a lot of hard work for me - I hope you're going to make it easy!
Proactive Pulse:
Let’s start at the beginning. What inspired you to create Optima, and how has the mission evolved?
James:
Yeah, that’s the big question. We’re going back about 20 years. I was newly appointed as a consultant and wanted to learn complex PCI, particularly CTOs. What struck me at the time was that there was a whole group of patients with blocked arteries and really bad angina - and no one seemed to want to treat them. The answer was always, “There’s nothing we can do,” which didn’t make sense to me.
Sure, it was more complex, but not impossible. I figured if you could learn the techniques, you could help those patients. So I went to my first CTO conference in New York - this is 21 years ago now - and it was a pretty small meeting, mostly driven by Japanese physicians. In Japan, bypass surgery wasn’t widely accepted, so they had to figure out how to treat these cases with PCI. And they did.
The problem was, they weren’t communicating what they were doing in a clear way. They’d show a case, it would take forever, and you couldn’t really tell what was going on. People were fascinated, but also intimidated. So, nobody adopted it. Back then in the UK, adoption was basically zero.
That’s when I started asking: what’s stopping people from learning and doing this? And it came down to understanding. People needed a way to grasp these techniques clearly so they could feel confident using them. That’s really where Optima began, making the complex understandable and adoptable to improve patient care.
Proactive Pulse:
And that core idea still drives Optima today?
James:
Completely. While we’ve expanded beyond CTOs into CT, physiology, complex PCI, calcium management, LV support, and more, the root issue is always the same. How do we reduce friction and help people adopt these techniques with confidence?
Proactive Pulse:
Proactive PCI is central to your educational philosophy. Why is that shift so significant?
James:
Yeah, it’s funny, people often think the thing that drives change is a new technology or technique. But it’s not. It’s adoption. It’s those small friction points that stop someone trying something new because they’re unsure, or they don’t fully understand it, or they’re just a bit scared.
The environment we work in matters too. PCI is done in a high-pressure setting. And when we’re under pressure, we fall back on shortcuts, what behavioural scientists call heuristics. Those shortcuts are based on our own experience, which might be limited. So we end up making decisions that aren’t always the best for the patient, not because we don’t care, but because of the environment we’re in.
What proactive PCI tries to do is give people the cognitive skills to make better decisions. To slow things down, make sense of the information, and approach each case in a more logical, structured way. In a sense, it’s about reducing harmful variability so patients don’t get different care just because they walked into a different lab on a different day.
And here’s where we flip the Nike slogan. Medicine often says, “Just do it!” But our message is: Don’t just do it. Think about it first. We’re all about bringing thoughtfulness back into the process, before the wire even goes in.
Proactive Pulse:
What trends and innovations in interventional cardiology are you most excited about right now?
James:
I think the biggest shift coming is the information revolution. We’re already seeing it everywhere, on our phones, with AI, but now it’s moving into the cath lab. The question is: how do we harness that power in a way that actually helps clinicians and patients?
CT is a great example. For complex cases, like CTOs or patients with a lot of calcium, it can help us plan better, predict outcomes, improve efficiency. And maybe most importantly, it helps patients feel like their care has been thought through. That their case wasn’t just one more in a busy list, but actually considered and planned. That matters.
When we can make those decisions ahead of time, predict risk, tailor treatment, we improve success rates and patient confidence. That’s where this is all heading.
Proactive Pulse:
How is Optima helping to lead that shift?
James:
We’re right at the front edge with this. Our CT planning course in Belgium is a great example, we run it every year, and we also collaborate with courses in the Middle East and the US. But it’s not just about CT. It’s about how we integrate everything - CT, physiology, imaging, even behavioural science - into a planning mindset.
And one thing that sets us apart is that we think about thinking. That’s metacognition, and it’s almost taboo in medicine. People say, “Just get on with it.” But we say the opposite- pause and think. We want clinicians to have the confidence and clarity to make better decisions—and know why they’re making them.
Proactive Pulse:
What’s next for Optima?
James:
We’ve got a packed programme ahead. Next up is Optima London. We’re starting with an invite-only session, bringing over a top presenter from the US to work with our core faculty on delivering sharper, more precise educational content.
Then we’ve got two days of open sessions in our “Why, How, Try” format. So: why you should care, how to apply it, and then the interactive bit - trying out the techniques and technologies with expert support.
Later in the year, we’ve got a collaboration with TCT in San Francisco, which we’re really excited about. And we’ve got loads of ongoing projects- video content, faculty insights, and of course, newsletters like this one - where we’ll keep sharing what we’re learning and where we’re going.
Proactive Pulse:
Thanks for sharing your time and insights. Lots to look forward to.
James:
Definitely. The mission hasn’t changed - help people think more clearly, adopt new techniques with confidence, and ultimately improve patient outcomes. And by bringing people together around that shared purpose, we’re building something that feels bigger than education - it’s a community.