Task force 3: Training in diagnostic and interventional cardiac catheterization: Endorsed by the Society for Cardiovascular Angiography and Interventions

Abstract

Since the second edition of Task Force 3 of the American College of Cardiology (ACC) Core Cardiology Training Symposium (COCATS) guidelines was published (1), both the cognitive knowledge and technical skill required of the invasive and interventional cardiologist have continued to grow. Concomitantly, the role of the cardiac catheterization laboratory in trainee education and as a clinical care facility continues to evolve. The cardiac catheterization laboratory serves as both a diagnostic and therapeutic facility. It has an important diagnostic role in the evaluation and management of all types of heart disease: coronary, valvular, congenital, and primary myocardial. This role includes invasive hemodynamic measurements and angiographic delineation of cardiovascular anatomy and pathology. The information derived from these studies has a complementary overlap with that derived from other diagnostic modalities such as echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI). This relationship has value both in enhancing diagnostic accuracy and in fostering the understanding of cardiovascular physiology, pathology, and pathophysiology. The widespread use of echocardiography in addition to the growing use of cardiovascular magnetic resonance (CMR) and CT angiography has also changed the practice of invasive and interventional cardiology. Patients with diagnostic echocardiographic hemodynamic assessment of valvular or myocardial/pericardial disease may be referred for diagnostic coronary angiography only. However, patients in whom the echocardiographic findings are conflicting are still referred to the catheterization laboratory for hemodynamic assessment; these patients are often exceedingly complex. Thus, somewhat paradoxically in this era of enhanced noninvasive imaging, the understanding and proper performance of detailed hemodynamic evaluation in such patients is of even greater importance. The therapeutic role of the cardiac catheterization laboratory continues to increase as interventional cardiology procedures are applied to increasingly complex and critically ill patients. Urgent catheterization and percutaneous revascularization are now considered to be the standard of care for patients with unstable coronary ischemic syndromes, ST-elevation myocardial infarction, and cardiogenic shock. Furthermore, new adjunctive pharmacologic regimens and interventional devices have emerged. In addition, many noncoronary therapeutic procedures including percutaneous closure of atrial septal defects and patent foramen ovale, valve repair or replacement, and septal artery ablation are currently in various stages of investigation and are likely to significantly expand the scope of the field of interventional cardiology. This evolution has increased the cognitive and technical knowledge base required of invasive and interventional cardiologists. Consequently, this document revises and updates the standards for training in invasive cardiology. The American Board of Internal Medicine (ABIM) provides an added qualification certifying examination in interventional cardiology, and the Residency Review Committee of the American Council for Graduate Medical Education (ACGME) has a formal accreditation mechanism for interventional cardiology training programs. The recommendations in this document are consistent with the requirements of the ABIM and the ACGME. In 1999, the ACC published a training statement on recommendations for the structure of an optimal adult interventional cardiology training program (2), and the recommendations are summarized in this document.