2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee

Bass, Theodore A.; Abbott, J. Dawn; Mahmud, Ehtisham; Parikh, Sahil A.; Aboulhosn, Jamil; Ashwath, Mahi L.; Baranowski, Bryan; Bergersen, Lisa; Chaudry, Hannah I.; Coylewright, Megan; Denktaş, Ali E.; Gupta, Kamal; Gutiérrez, Jorge; Haft, Jonathan W.; Hawkins, Beau M.; Herrmann, Howard C.; Kapur, Navin K.; Kilic, Sena; Lesser, John R.; C., Huie Lin; Mendirichaga, Rodrigo; Nkomo, Vuyisile T.; Park, Linda G.; Phoubandith, Dawn R.; Quader, Nishath; Rich, Michael W.; Rosenfield, Kenneth; Sabri, Saher S.; Shames, Murray L.; Shernan, Stanton K.; Skelding, Kimberly A.; Tamis-Holland, Jacqueline; Thourani, Vinod H.; Tremmel, Jennifer A.; Uretsky, Seth; Wageman, Jessica; Welt, Frederick G.P.; Whisenant, Brian; White, Christopher; Yong, Celina M.

doi:10.1161/hcv.0000000000000088

Cited by 11 publications

(9 citation statements)

References 73 publications

(115 reference statements)

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“…Additionally, the recent European Association of Percutaneous Cardiovascular Interventions consensus statement also recommends the use of imaging guided percutaneous coronary intervention only in select groups of patients with complex lesions (including long lesions, chronic total occlusions, or left main lesions) and patients presenting with acute coronary syndrome, citing less benefit in non-complex lesions or patients with more stable clinical presentation 43. Given the observed benefits of intravascular imaging guided percutaneous coronary intervention, reassessing current guidelines and considering revisions to better reflect the evidence presented in this study are imperative 44…”

Section: Discussionmentioning

confidence: 97%

Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis

Khan,

Agarwal,

Arshad

et al. 2023

BMJ

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Objective To assess the absolute treatment effects of intravascular imaging guided versus angiography guided percutaneous coronary intervention in patients with coronary artery disease, considering their baseline risk. Design Systematic review and meta-analysis. Data sources PubMed/Medline, Embase, and Cochrane Library databases up to 31 August 2023. Study selection Randomized controlled trials comparing intravascular imaging (intravascular ultrasonography or optical coherence tomography) guided versus coronary angiography guided percutaneous coronary intervention in adults with coronary artery disease. Main outcome measures Random effect meta-analysis and GRADE (grading of recommendations, assessment, development, and evaluation) were used to assess certainty of evidence. Data included rate ratios and absolute risks per 1000 people for cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and target lesion revascularization. Absolute risk differences were estimated using SYNTAX risk categories for baseline risks at five years, assuming constant rate ratios across different cardiovascular risk thresholds. Results In 20 randomized controlled trials (n=11 698), intravascular imaging guided percutaneous coronary intervention was associated with a reduced risk of cardiac death (rate ratio 0.53, 95% confidence interval 0.39 to 0.72), myocardial infarction (0.81, 0.68 to 0.97), stent thrombosis (0.44, 0.27 to 0.72), target vessel revascularization (0.74, 0.61 to 0.89), and target lesion revascularization (0.71, 0.59 to 0.86) but not all cause death (0.81, 0.64 to 1.02). Using SYNTAX risk categories, high certainty evidence showed that from low risk to high risk, intravascular imaging was likely associated with 23 to 64 fewer cardiac deaths, 15 to 19 fewer myocardial infarctions, 9 to 13 fewer stent thrombosis events, 28 to 38 fewer target vessel revascularization events, and 35 to 48 fewer target lesion revascularization events per 1000 people. Conclusions Compared with coronary angiography guided percutaneous coronary intervention, intravascular imaging guided percutaneous coronary intervention was associated with significantly reduced cardiac death and cardiovascular outcomes in patients with coronary artery disease. The estimated absolute effects of intravascular imaging guided percutaneous coronary intervention showed a proportional relation with baseline risk, driven by the severity and complexity of coronary artery disease. Systematic review registration PROSPERO CRD42023433568.

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Section: Discussionmentioning

confidence: 97%

Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis

Khan,

Agarwal,

Arshad

et al. 2023

BMJ

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“…However, those educational resources are of limited availability due to scarcity and high costs [ 6 ]. Because of these limitations, AHA and ACC guidelines do not even discuss recommendation including such techniques in interventional cardiologist training guidelines [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of novel electrophysiology simulator—a survey study

Koźlik,

Kosiuk,

Cogiel

et al. 2024

Adv Simul

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Background Invasive electrophysiology (EP) training requires intellectual skills related to the interpretation of intracardiac electrograms. The classic approach to the education of young electrophysiologists focused solely on theoretical knowledge and overseen procedures in patients as no real-life-like simulation of EP studies was available. Objective The purpose of this study was to assess a novel tool for EP training based on fully interactive, online simulator providing real clinical experience to the users. Methods EP simulator users access a system with simulated electrocardiogram, mimicking signals recorded by a catheter. Assessment of EP simulator by 40 electrophysiologists from 16 countries was collected via online questionnaire. Results The realism of ECG signals was described as excellent or very good by 90% of responders, of intracardial signals by 82.5%. Realism of signal interactions and user experience was judged as excellent or very good by 75% and 70% accordingly. One hundred percent of users agree definitely or mostly that EP Simulator helps to translate theoretical into practical knowledge. Of responders, 97.5% would include it in EP training programs as it is extremely or very useful for training purposes in the opinion of 87.5%. Of responders, 72.5% think that training on EP simulator can potentially reduce the rate of complications. In 87.5%, the overall experience was completely or mostly satisfying and would be recommended by 100% of responders. Conclusion EP simulator is a feasible tool for training of young electrophysiologist, and it may be potentially included in the cardiologist curriculum. We should particularly emphasize the positive respondents’ assessment of EP simulator overall realism.

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“…4 Consistent with this finding, less than one-third of operators accounted for over two-thirds of TEERs performed nationally in procedures that fellows must complete. 6 With high-volume centers performing a majority of TEER cases, 4 training programs at hospitals with minimal operational output may struggle to provide the required caseload for certification; programs located in rural or low-income areas may be affected more by the influence of disparities and availability. For programs that can meet minimum requirements, an operator's mastery may still be heavily influenced by overall operational volume.…”

Section: Discussionmentioning

confidence: 99%

“…Programs wishing to utilize TEER must perform at least 25 mitral valve surgical procedures, of which 10 must be mitral valve repair, and have at least two cardiothoracic surgeons experienced in valvular surgery 5 . For educational competency, the 2023 American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions guidelines detailed a minimum of 20 TEER procedures that fellows must complete 6 . With high‐volume centers performing a majority of TEER cases, 4 training programs at hospitals with minimal operational output may struggle to provide the required caseload for certification; programs located in rural or low‐income areas may be affected more by the influence of disparities and availability.…”

Section: Discussionmentioning

confidence: 99%

Geographic variability and operator trends of transcatheter edge‐to‐edge repair in the United States

Heaton,

Imburgio,

Dandu

et al. 2023

Cathet Cardio Intervent

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BackgroundsTranscatheter edge‐to‐edge repair (TEER) devices are used for primary mitral regurgitation (MR) and secondary MR. Despite the growing use of TEER devices, there have not been many studies on operator experience or procedure volumes by state.AimsWe aimed to investigate nationwide operator volume trends and geographic variation in access to TEER.MethodsThe United States Center for Medicare and Medicaid Services (CMS) National Medicare Provider Utilization and Payment Database (MPUPD) was analyzed between 2015 and 2020 for initial TEER procedures.ResultsProcedure volume and total operators increased yearly from 2015 to 2019 but declined in 2020. Mean annual procedure volume per operator varied significantly by state, between 0 in multiple states and 35 in North Dakota. In 2019, 994 unique operators were identified, with 295 operators documented performing 10 or more procedures (29.68%). Operators performing 10 or more TEER procedures provided 68.46% of all operations in 2019, averaging 20.94 procedures per operator.ConclusionsTEER procedures are becoming increasingly common as more operators are being trained. However, significant variability exists in the procedural volume per operator.

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2023 ACC/AHA/SCAI Advanced Training Statement on Interventional Cardiology (Coronary, Peripheral Vascular, and Structural Heart Interventions): A Report of the ACC Competency Management Committee

Cited by 11 publications

References 73 publications

Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis

Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis

Assessment of novel electrophysiology simulator—a survey study

Geographic variability and operator trends of transcatheter edge‐to‐edge repair in the United States

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