Interventional Cardiology Fellowship Research Articles

Interventional cardiologists' perspectives and knowledge towards artificial intelligence.

Artificial intelligence (AI) is increasingly utilized in interventional cardiology (IC) and holds the potential to revolutionize the field. We conducted a global, web-based, anonymous survey of IC fellows and attendings to assess the knowledge and perceptions of interventional cardiologists regarding AI use in IC. A total of 521 interventional cardiologists participated in the survey. The median age range of participants was 36 to 45 years, most (51.5%) practice in the United States, and 7.5% were women. Most (84.7%) could explain well or somehow knew what AI is about, and 63.7% were optimistic/very optimistic about AI in IC. However, 73.5% believed that physicians know too little about AI to use it on patients and most (46.1%) agreed that training will be necessary. Only 22.1% were currently implementing AI in their personal clinical practice, while 60.6% estimated implementation of AI in their practice the next 5 years. Most agreed that AI will increase diagnostic efficiency, diagnostic accuracy, treatment selection, and healthcare expenditure, and decrease medical errors. The most tried AI-powered tools were image analysis (57.3%), ECG analysis (61.7%), and AI-powered algorithms (45.9%). Interventional cardiologists practicing in academic hospitals were more likely to have AI tools currently implemented in their clinical practice and to use them, women had a higher likelihood of expressing concerns regarding AI, and younger interventional cardiologists were more optimistic about AI integration in IC. Our survey suggests a positive attitude of interventional cardiologists regarding AI implementation in the field of IC.

International survey of chronic total occlusion percutaneous coronary intervention operators.

Contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI) practice has received limited study. To examine the contemporary CTO PCI practice. We performed an online, anonymous, international survey of CTO PCI operators. Five hundred forty-fiveCTO PCI operators and 190 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Almost half were from the United States (41%), most (93%) were men, and the median h/week spent in the hospital was 58. Median annual case numbers were 205 (150-328) for PCIs and 20 (5-50) for CTO PCIs. Almost one-fifth (17%) entered CTO cases into registries, such as PROGRESS-CTO (55%) and EuroCTO (20%). More than one-third worked at academic institutions (39%), 31% trained dedicated CTO fellows, and 22% proctored CTO PCI. One-third (34%) had dedicated CTO PCI days. Most (51%) never discharged CTO patients the same day, while 17% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 38% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (81%), PROGRESS-CTO (35%), and PROGRESS-CTO complications scores (30%). Coronary artery perforation was encountered within the last month by 19%. On a scale of 0-10, the median comfort levels in treating coronary artery perforation were: covered stents 8.8 (7.0-10), coil embolization 5.0 (2.1-8.5), and fat embolization 3.7 (0.6-7.3). Most (51%) participants had a complication cart/kit and 25% conducted regular complication drills with catheterization laboratory staff. Contemporary CTO PCI practices vary widely. Further research on barriers to following the guiding principles of CTO PCI may improve patient outcomes.

Abstract 18105: Lean Six Sigma Approach to Improve Post Percutaneous Coronary Intervention Cardiac Rehab Referral Rates

Background: Cardiac rehabilitation referral rates remain low despite known benefits including decreased mortality and improved quality of life. Studies have identified factors tied to both positive and negative predictors of referral rates, however, overall, it appears to be due to site-specific variation demonstrating the need for hospital-level intervention. Aims: This quality improvement study aimed to improve cardiac rehabilitation referral rates after PCI at our institution utilizing the Lean Sigma Six (LSS) approach, which has been described as a means to improving the quality of healthcare delivery. Methods: An interdisciplinary team used the Define-Measure-Analyze-Improve-Control (DMAIC) framework to implement this study. A GEMBA walk i.e., personal observation of workflow was performed. We Define d and Measure d process of cardiac rehabilitation and the referral rates. We Analyzed to identify that the orders were being placed by multiple team members including residents, general and interventional cardiology fellows, attendings, and nurse practitioners. Process maps were created, and our Intervention was to involve interventional cardiology fellows as stakeholders best suited to place orders since they are involved in all PCIs at our institution. Education was provided specifically to them beginning in July 2022. Statistical Process Control charts were used to analyze data trends from 2019 - 2022 where a total of 3046 PCIs were performed. Control process involved reinforcing the effect of intervention in quarterly meetings. Results: Baseline referral rates ranged from 10-60%. A significant increase in cardiac rehabilitation referral rate achieving a target referral greater than 90% was observed and maintained through the subsequent quarters. Conclusion: LSS is a powerful methodology to examine causes of delay in care. Intervention using LSS principles and tools, may help improve system processes to achieve desired quality outcomes.

Abstract 14721: International Chronic Total Occlusion Percutaneous Coronary Intervention Operator Survey

Background: Contemporary chronic total occlusions (CTO) percutaneous coronary intervention (PCI) practice has received limited study. Methods: We performed an online, anonymous, international survey of CTO PCI operators. Results: 104 CTO PCI operators and 12 interventional cardiology fellows with an interest in CTO PCI participated in this survey. Most were from the United States (53%), men (95%), and spent a median of 60 hours/week in the hospital. Median annual case numbers were 250 (150-400) for PCIs and 43 (10-85) for CTO PCIs (Figure). Almost half (42%) entered CTO cases into registries, mainly into PROGRESS-CTO (78%) and EuroCTO (11%). Most worked at academic institutions (55%), 55% trained dedicated CTO fellows, and 43% proctored CTO PCI. Almost half (43%) had dedicated CTO PCI days, and 54% performed dual access >90% of the time. Nearly half (42%) never discharged CTO patients the same day, while 20% discharged CTO patients the same day >50% of the time. After successful guidewire crossing, 51% used intravascular imaging >90% of the time. Most used CTO scores including J-CTO (82%), PROGRESS-CTO (42%), and PROGRESS-CTO complication scores (24%). Coronary artery perforation was encountered within the last month by 31%, and within 1-6 months by 35%. On a scale of 0-10, the median comfort levels were: covered stents 9.7 (8.2-10), coil embolization 8.0 (5.0-9.7), and fat embolization 5.0 (2.0-9.4). The majority (55%) had a complication cart/kit and 22% conducted regular complication drills with catheterization laboratory staff. Conclusion: Our survey provides information on the contemporary CTO PCI practices.

Interventionalist Hand Motion Recognition With Convolutional Neural Network in Robot-Assisted Coronary Interventions

The development of procedural competencies by interventional cardiology fellows for minimally invasive treatment of cardiac diseases depend on their effective training and evaluation. Learning tool manipulation for safe robotic percutaneous coronary interventions requires expert supervision and use of high-fidelity systems. However, with limited proficiency for real-time hand motion recognition. Therefore, this study proposes a deep learning-based model for identifying operators’ actions. The proposed model is based on the convolutional neural network that consist of one dimensional convolutional layers for automatic feature map extraction, down sampling, and fully connected layers for inference. The developed models were evaluated using a multi-modal dataset collected from sensory glove, EM, and sEMG sensors and real-time angiograms in the course of in-vivo catheterization trials performed by nine subjects (two experts and seven novices) using a custom-built robotic catheter system. The results indicate that the model achieves a 92–96% accuracy in identifying five actions across four clusters compared with a recognition performance of 83% when recognizing all six actions. Furthermore, we compared the proposed model performance with existing studies, the analyses show that our model has a 2-3% higher accuracy for five-action recognition. Therefore, the proposed model could be employed for real-time hand motion recognition in R-PCI trials.

E-35 | Educational Experience of Interventional Cardiology Fellows in the United States and Canada

E-35 | Educational Experience of Interventional Cardiology Fellows in the United States and Canada

Comparing the Efficacy and Success Rate of Radial Artery Approach under Ultrasound Guidance and Palpation Technique for Coronary Intervention at Central Chest Institute of Thailand

Background: Previous studies of ultrasound guidance for transradial artery access during coronary angiography or interventional procedures demonstrate improving success rate, number of attempts, and short-time access in radial artery cannulation. Objective: To compare the benefit of ultrasound guidance radial artery access during coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpation technique in experienced and inexperienced operators. Materials and Methods: A randomized prospective study was performed between October 2021 and April 2022. One hundred sixty-four patients were randomized into three groups. The first group, group I (55 cases), underwent radial artery puncture with ultrasound guidance by an experienced interventionist. The second group, group II (56 cases), underwent radial artery puncture using the palpation technique by another experienced interventionist. The third group, group III (53 cases), was also assigned to radial artery puncture with the palpation technique, however, performed by three interventional cardiology fellows. Results: The success rate of radial cannulation was 55 (100%) in group I, 52 (92.9%) in group II, and 48 (90.6%) in group III (p=0.060). Firstattempt success rates in the three groups were 83.6%, 75%, and 69.8%, respectively (p=0.233). The median number of attempts was not significantly different (p=0.208). Time to access the radial artery in group I was reduced significantly compared to the palpation technique in group II and group III (p<0.001). There were no significant differences in complications such as difficult access, access site crossover, radial spasm, and hematoma/ bleeding complication (p=0.135, 0.367, 0.132, and 0.700, respectively). Conclusion: In experienced operators, an ultrasound-guided technique has been shown to have beneficial advantages in reducing the time to access radial artery cannulation compared to experienced and inexperienced operators using the palpation technique. Keywords: Transradial catheterization; Ultrasound guide

Educational Experience of Interventional Cardiology Fellows in the United States and Canada

BackgroundThe COVID-19 pandemic and iodinated contrast shortage may have affected interventional cardiology (IC) fellowship training. ObjectivesThe aim of this study was to investigate the educational experience of first-year IC fellows in the United States and Canada. MethodsA 59-question online survey was conducted among 2021-2022 first-year IC fellows in the United States and Canada. ResultsOf the 360 IC fellows invited to participate, 111 (31%) responded; 95% were from the United States, and 79% were men. Participants were mostly from university programs (70%), spent 61 to 70 hours/week in the hospital, and had an annual percutaneous coronary intervention case number of <200 (5%), 200 to 249 (8%), 250 to 349 (33%), 350 to 499 (39%), 500 to 699 (12%), or ≥700 (3%). For femoral access, a micropuncture needle was used regularly by 89% and ultrasound-guided puncture by 81%, and 43% used vascular closure devices in most cases (>80%). Intravascular ultrasound was performed and interpreted very comfortably by 62% and optical coherence tomography (OCT) by 32%, and 20% did not have access to OCT. Approximately one-third felt very comfortable performing various atherectomy techniques. Covered stents, fat embolization, and coil embolization were used very comfortably by 14%, 4%, and 3%, respectively. Embolic protection devices were used very comfortably by 11% to 24% of IC fellows. Almost one-quarter of fellows (24%) were warned about their high radiation exposure. Eighty-four percent considered IC fellowship somewhat or very stressful, and 16% reported inadequate psychological support. ConclusionsThis survey highlights opportunities for improvement with regard to the use of intravascular imaging, atherectomy techniques, complication prevention and management strategies, radiation awareness and mitigation, and psychological support.

Book Review Manual of Chronic Total Occlusion Percutaneous Coronary Interventions: A Step-by-Step Approach

The Manual of Chronic Total Occlusion Percutaneous Coronary Interventions: A Step-by-Step Approach, Third Edition is a useful reference for percutaneous coronary intervention (PCI) with chronic total occlusion (CTO). Written by national and international experts in the field of CTO and edited by Emmanuel Brilakis, this book gives the steps necessary to do CTO PCI, the pitfalls to watch out for, and how to modify tactics if we face CTO complications. This manual book is dedicated and made for interventional cardiologists, interventional cardiology fellows, general cardiology residents, also cardiac catheterization laboratory staff. This book will give you the latest state of the art in the field of CTO PCI. In this new edition, new numbers, images, and algorithms have been developed and shared to reflect the CTO PCI updates. Additionally, this update includes links to nearly 200 of his CTO PCI cases. The structure of the book has been completely revised to align with the recently published Manual of Percutaneous Coronary Intervention.

Abstract 13866: Interventional Heart Failure: Current State of the Field

Introduction: The expanding intersection between interventional cardiology (IC) and advanced heart failure (AHF) has raised interest in an Interventional Heart Failure (IHF) specialty. Methods: We conducted a survey among cardiologists trained in AHF and IC to investigate the state of this new field. This was distributed by the Society of Cardiovascular Angiography and Interventions (SCAI) via their newsletter and publicized via Twitter. Results: Data from 55 respondents in 47 medical centers (22% outside the United States) was acquired. In the US, these centers are concentrated in the South (43%) and Northeast (23%), and commonly host advanced therapies programs: 89% ECMO, 69% durable LVAD and 56% heart transplant. Respondents were 94% men; 47% were 35-45 y. and 41% were &amp;gt45y. old. Foreign physicians accounted for 13%. In the US, 56% of respondents were international medical graduates (IMGs) and 31% were American medical graduates (AMGs). Most completed training after 2013 (69%). IC fellowship was completed first by 47% of AMGs, 50% of IMGs (Figure). Only 23% trained beyond AHF and IC. Area of clinical focus is coronary artery disease (CAD) 42%, cardiogenic shock (CS) 40%, structural procedures 13%. Respondents regularly implant IABP (95%), Impella (83%) and VA-ECMO (69%). Time devoted to IC is 50-80% in 49% (Figure). Most take STEMI call (84%) and do CCU rounds (95%) while only 21% take donor call. Only 32% feel their training was excessive and 82% would repeat it. Most (84%) support the creation of integrated 2-year AHF and IC fellowships. Conclusions: We report the first survey assessing the IHF specialty. We observed a growing workforce focused on CAD, mechanical circulatory support and CS. Development of integrated training pathways is viewed favorably by the IHF community.

Femoral in the Time of Radial

Femoral in the Time of Radial

#SoMe for #IC: Optimal use of social media in interventional cardiology.

Social media allows interventional cardiologists to disseminate and discuss research and clinical cases in real-time, to demonstrate and learn innovative techniques, to build professional networks, and to reach out to patients and the general public. Social media provides a democratic platform for all participants to influence the conversation and demonstrate their expertise. This review addresses the use of social media for these purposes in interventional cardiology, as well as respect for patient privacy, how to get started on social media, the creation of high-impact social media content, and the role of traditional journals in the age of social media. In the future, we hope that interventional cardiology fellowship programs will incorporate social media training into their curricula. In addition, professional societies may adapt to the rapid dissemination of data on social media by developing processes to update guidelines more rapidly and more frequently.

Navigating Early Careers in Heart Failure in the Era of Novel Coronavirus Disease-2019

Navigating Early Careers in Heart Failure in the Era of Novel Coronavirus Disease-2019

TCT CONNECT-224 Interventional Cardiology Fellowship Training During COVID-19 Pandemic: Facts and Challenges

Background: The coronavirus disease-2019 (COVID-19) pandemic has represented unprecedented challenge to health care system During such global threat, it is very difficult if not impossible to disregard the impact of this crisis on fellows-in-training (FITs) Accordingly, we sought to assess the impact of the COVID-19 pandemic on cardiology FITs in form of their volume of procedures and the challenges they confront during pandemic Methods: Study included cardiology FITs from 5 cardiac teaching centers, a printed survey in form of pdf file was sent to FITs by telegram;the survey consisted of 10 sections and included 43 questions, which focused on number and type of cardiac procedures done by the candidates before the pandemic (from December 2019 to February 2020) and during the pandemic in Iraq (March to June 2020) The survey also inquired on personal protective equipment (PPE) provided to candidates during duties Results: The survey included 49 candidates;77 6% were adult cardiology FIT, 20 4% were pediatric cardiology FIT, and 1 candidate was EP FIT All cardiac interventions dropped with highest rate of drop of volume in structural heart interventions and in diagnostic angiographies The candidates reported undersupply of PPE during pandemic as 59 2% reported crucial need for more PPE supply during duties;22 4% reported no clear protocol in their hospitals to deal with cardiac patients during pandemic;59 2% reported need for regular virtual teaching webinars to upscale education [Formula presented] Conclusion: There is remarkable disruption in cardiology training caused by COVID-19;every effort should be taken by decision-makers to prepare a well-equipped workforce nucleus to counteract this pandemic and improve cardiovascular care Categories: OTHER: COVID-19

Impact of the COVID-19 pandemic on interventional cardiology training in the United States.

ObjectivesWe sought to determine the effect of COVID‐19 related reduction in elective cardiac procedures and acute coronary syndrome presentations on interventional cardiology (IC) training.BackgroundThe COVID‐19 pandemic has significantly disrupted healthcare in the United States, including cardiovascular services. The impact of COVID‐19 on IC fellow training in the United States has not been assessed.MethodsThe Society for Cardiovascular Angiography and Interventions (SCAI) surveyed IC fellows training in both accredited and advanced non‐accredited programs, as well as their program directors (PD).ResultsResponses were received from 135 IC fellows and 152 PD. All respondents noted reductions in procedural volumes beginning in March 2020. At that time, only 43% of IC fellows had performed >250 PCI. If restrictions were lifted by May 15, 2020 78% of IC fellows believed they would perform >250 PCI, but fell to only 70% if restrictions persisted until the end of the academic year. 49% of IC fellows felt that their procedural competency was impaired by COVID‐19, while 97% of PD believed that IC fellows would be procedurally competent at the end of their training. Most IC fellows (65%) noted increased stress at work and at home, and many felt that job searches and/or existing offers were adversely affected by the pandemic.ConclusionThe COVID‐19 pandemic has substantially affected IC training in the United States, with many fellows at risk of not satisfying current program procedural requirements. These observations support a move to review current IC program requirements and develop mitigation strategies to supplement gaps in education related to reduced procedural volume.

Impact of the COVID‐19 pandemic on interventional cardiology fellowship training in the New York metropolitan area: A perspective from the United States epicenter

BackgroundThe healthcare burden posed by the coronavirus disease 2019 (COVID‐19) pandemic in the New York Metropolitan area has necessitated the postponement of elective procedures resulting in a marked reduction in cardiac catheterization laboratory (CCL) volumes with a potential to impact interventional cardiology (IC) fellowship training.MethodsWe conducted a web‐based survey sent electronically to 21 Accreditation Council for Graduate Medical Education accredited IC fellowship program directors (PDs) and their respective fellows.ResultsFourteen programs (67%) responded to the survey and all acknowledged a significant decrease in CCL procedural volumes. More than half of the PDs reported part of their CCL being converted to inpatient units and IC fellows being redeployed to COVID‐19 related duties. More than two‐thirds of PDs believed that the COVID‐19 pandemic would have a moderate (57%) or severe (14%) adverse impact on IC fellowship training, and 21% of the PDs expected their current fellows' average percutaneous coronary intervention (PCI) volume to be below 250. Of 25 IC fellow respondents, 95% expressed concern that the pandemic would have a moderate (72%) or severe (24%) adverse impact on their fellowship training, and nearly one‐fourth of fellows reported performing fewer than 250 PCIs as of March 1st. Finally, roughly one‐third of PDs and IC fellows felt that there should be consideration of an extension of fellowship training or a period of early career mentorship after fellowship.ConclusionsThe COVID‐19 pandemic has caused a significant reduction in CCL procedural volumes that is impacting IC fellowship training in the NY metropolitan area. These results should inform professional societies and accreditation bodies to offer tailored opportunities for remediation of affected trainees.

Impact of trainee involvement on patient radiation exposure and contrast volumes during invasive cardiac procedures.

The impact of cardiology fellows (CFs) and interventional cardiology fellows (ICFs) on patient radiation and contrast exposure during diagnostic coronary angiography and percutaneous coronary intervention is unknown. Between 2011 and 2014, 16,175 cases were retrospectively assessed involving 27 CFs, 22 ICFs and 24 staff as primary operators. During diagnostic coronary angiography, ICFs administered the lowest radiation dose (5,648±5,523 cGy*cm2; 1.30 ± 1.27 mSv)-achieving 22% less radiation than the staff (6,889±4,294 cGy*cm2; 1.58 ± 0.99 mSv) and 36% less than CFs (7,700±6,751 cGy*cm2; 1.77 ± 1.55 mSv) (p<0.01). When adjusted for access site, CFs administered more radiation than either the ICFs or staff. However, differences between ICFs and staff were exclusively observed during transradial procedures (p<0.01). With regards to contrast administration, ICFs administered less contrast (126.3 ± 57.6 mL) than either CFs (130±52.4 mL) or staff (132.7±47.6 mL) (p<0.01)-again, a finding isolated to the transradial cohort. Of the 6,751 percutaneous coronary intervention cases, no significant differences existed between the ICFs or staff cardiologists in patient radiation exposure-but a CF as the primary operator resulted in an 18% increase in radiation exposure. Notably, contrast use was not different amongst the types of operators (p<0.05). In conclusion, having a cardiology fellow as primary operator during invasive cardiac procedures increases patient radiation exposure and minimally increases contrast administration. Strategies to minimize patient radiation exposure while maintaining trainee involvement should be evaluated.

Interest in Vascular Surgery as a Specialty in a Climate of Competitive Fields

Vascular surgery is unique in that it combines intricate skill sets, involves almost every anatomic territory, and crosses over with other subspecialties. Recent editorial publications have insinuated that the interest in our specialty is declining. We sought to examine the relative interest in vascular surgery compared with interventional cardiology (IC), cardiothoracic surgery (CT), and interventional radiology (IR). Reviews of the National Residency Match Program and the American Board of Internal Medicine were performed for both fellowship and residency match data. Search terms were compared using Google trends. Job outlook was examined on the Cardiothoracic Surgery Network, Society for Vascular Surgery, Society of Interventional Radiology, and American College of Cardiology websites. Applications to fellowship positions offered for CT experienced a 44% (1.37/0.95) increase from 2014 to 2018, whereas vascular surgery experienced only an 8% (1.07/0.99) increase. In the past year, vascular surgery was the only field to experience a decline, 5% (1.12 to 1.07), whereas IC increased by 8% (1.01 to 1.09). In 2018, there were 2.0 U.S. medical students applying to each CT position compared with 1.0 applying to vascular surgery. Google trend data during the past 10 years show that interest has remained higher for search terms “interventional cardiology fellowship” (average 41/100) and “interventional radiology fellowship” (average 39/100) compared with “vascular surgery fellowship” (25/100) and “cardiothoracic surgery fellowship” (18/100). One of the most often related queries according to Google trends was salary. The average salary for a vascular surgeon in 2018 was $484,740 vs that of IR ($610,500 in 2016), IC ($612,910), and CT ($584,287). With regard to job outlook, there were most recently 108 jobs per 123 graduates currently posted for cardiothoracic surgeons, 112 of 225 for interventional radiologists, 249 of 309 for interventional cardiologists, and 91 of 166 for vascular surgeons. The current interest in vascular surgery is on the decline, whereas a concurrent increase in interest is occurring for CT, IC, and IR subspecialties. The reason for this is unclear but needs to be examined to provide high-quality trainees in a climate of continuous increasing demand and extreme competition from other subspecialties.

Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging

Competency-Based Assessment of Interventional Cardiology Fellows’ Abilities in Intracoronary Physiology and Imaging

Primary percutaneous intervention of the right coronary artery in a setting of anomalous origination of left coronary artery from the opposite sinus of Valsalva

Introduction. Coronary artery anomalies are infrequent but anticipated findings during percutaneous coronary interventions (PCI). Compared to consistent reporting in angiographic series, they seem to be underreported in interventional studies, and particularly in the setting of primary PCI, where their prompt recognition is of the utmost importance. Case report. We present a 50 years old male with inferior ST-elevation of myocardial infarction (STEMI) and right ventricular involvement with solitary ostium for all three coronary arteries in the right aortic sinus of Valsalva. The patient had an extremely rare variant of coronary artery origination belonging to the type A4b2c2 of Angelini?s classification. Correspondingly, it belongs to the left Anomalous origination of a Coronary Artery from the Opposite Sinus of Valsalva (ACAOS) class with the intraseptal course of left anterior descending artery. We managed successfully to implant a drug eluting stent in the proximal right coronary artery in a lengthy and stormy procedure, with the need for guiding catheter exchange, temporary pacing and dealing with no-reflow phenomenon. Conclusion. We summarize diagnostic hints for angiographic recognition of dominant variants of the left ACAOS and practical aspects of performing PCI in such patients. Also, we debate on the functional significance of coronary anomalies and its further implications from the prognostic and therapeutic aspects. We propose adoption of the novel classification of coronary anomalies of Angelini?s group in the routine clinical practice. Finally, we call for the inclusion of specific training in coronary artery anomalies into the interventional cardiology fellowship curriculum.