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

2020; Lippincott Williams & Wilkins; Volume: 13; Issue: 2 Linguagem: Inglês

10.1161/circinterventions.119.008760

1941-7632

Erin Flattery, Hussein Rahim, Gregory Petrossian, Evan Shlofmitz, Fotis Gkargkoulas, Mitsuaki Matsumura, Ajay J. Kirtane, Sahil A. Parikh, Manish A. Parikh, Jeffrey W. Moses, Dimitri Karmpaliotis, Ori Ben‐Yehuda, Martin B. Leon, Allen Jeremias, Richard Shlofmitz, Gregg W. Stone, Akiko Maehara, Ehtisham Mahmud, Gary S. Mintz, Ziad A. Ali,

Cardiac Imaging and Diagnostics

HomeCirculation: Cardiovascular InterventionsVol. 13, No. 2Competency-Based Assessment of Interventional Cardiology Fellows' Abilities in Intracoronary Physiology and Imaging Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBCompetency-Based Assessment of Interventional Cardiology Fellows' Abilities in Intracoronary Physiology and Imaging Erin Flattery, MD, Hussein M. Rahim, MD, Gregory Petrossian, BS, Evan Shlofmitz, DO, Fotis Gkargkoulas, MD, Mitsuaki Matsumura, BS, Ajay J. Kirtane, MD, SM, Sahil A. Parikh, MD, Manish A. Parikh, MD, Jeffrey W. Moses, MD, Dimitri Karmpaliotis, MD, PhD, Ori Ben-Yehuda, MD, Martin B. Leon, MD, Allen Jeremias, MD, Richard A. Shlofmitz, MD, Gregg W. Stone, MD, Akiko Maehara, MD, Ehtisham Mahmud, MD, Gary S. Mintz, MD and Ziad A. Ali, MD, DPhil Erin FlatteryErin Flattery NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Hussein M. RahimHussein M. Rahim NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). , Gregory PetrossianGregory Petrossian St Francis Hospital, Roslyn, NY (G.P., A.J., Z.A.A.). , Evan ShlofmitzEvan Shlofmitz MedStar Washington Hospital Center, DC (E.S.). , Fotis GkargkoulasFotis Gkargkoulas NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Mitsuaki MatsumuraMitsuaki Matsumura Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Ajay J. KirtaneAjay J. Kirtane NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Sahil A. ParikhSahil A. Parikh NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Manish A. ParikhManish A. Parikh NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Jeffrey W. MosesJeffrey W. Moses NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Dimitri KarmpaliotisDimitri Karmpaliotis NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Ori Ben-YehudaOri Ben-Yehuda NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Martin B. LeonMartin B. Leon NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Allen JeremiasAllen Jeremias St Francis Hospital, Roslyn, NY (G.P., A.J., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Richard A. ShlofmitzRichard A. Shlofmitz Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Gregg W. StoneGregg W. Stone Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.). , Akiko MaeharaAkiko Maehara NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). , Ehtisham MahmudEhtisham Mahmud Division of Cardiology, School of Medicine, University of California-San Diego (E.M.). , Gary S. MintzGary S. Mintz Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). and Ziad A. AliZiad A. Ali Correspondence to: Ziad A. Ali, MD, DPhil, Columbia University Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019. Email E-mail Address: [email protected] NewYork-Presbyterian Hospital/Columbia University Medical Center (E.F., H.M.R., F.G., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.M., Z.A.A.). St Francis Hospital, Roslyn, NY (G.P., A.J., Z.A.A.). Cardiovascular Research Foundation, New York, NY (E.S., F.G., M.M., A.J.K., S.A.P., M.A.P., J.W.M., D.K., O.B.-Y., M.B.L., A.J., R.A.S., G.W.S., A.M., G.S.M., Z.A.A.). Originally published24 Jan 2020https://doi.org/10.1161/CIRCINTERVENTIONS.119.008760Circulation: Cardiovascular Interventions. 2020;13:e008760Although coronary angiography remains necessary for percutaneous coronary intervention, it provides limited information about lesion morphology, functional significance, and percutaneous coronary intervention results—limitations that are addressed by intravascular imaging and invasive physiology with demonstrated improved procedural and clinical outcomes.1,2 Nevertheless uptake remains low, especially among early career practitioners.3 Data regarding preparation of interventional cardiology fellows-in-training (IC-FIT) to use these modalities is scarce. We assessed IC-FIT perceptions regarding training and competency-based independence in invasive physiology, intravascular ultrasound (IVUS), and optical coherence tomography (OCT).An anonymous survey was distributed at the annual Cardiovascular Research Foundation Interventional Fellows Course in April 2018 and 2019 before the Imaging and Physiology session. Survey questions first assessed self-perceived training sufficiency using a multiple-choice scale that included expert, sufficient for clinical utility, rudimentary, or none. IC-FIT next assessed ability to perform specific core competencies independently, with assistance, or unable. Physiology competencies included device set-up and ability to identify aortic pressure dampening, distorted wave forms, and pressure drift. IVUS and OCT competencies included device set-up and ability to identify different plaque morphologies; reference segments for stent positioning, stent length, and diameter; minimal stent area; edge dissections; and malapposition. Student t test was used to compare differences between 2018 and 2019.Overall, 259 surveys were collected; complete responses were from 29% (74) IC-FIT. Others were general cardiology fellows or specialist imaging fellows. Demographic information was not collected in 2018; demographics obtained in 2019 showed that 77% (57) were from the United States and 74% (55) trained at University hospitals.Among IC-FIT, expert or sufficient training was initially reported by 95% (70) in invasive physiology, 82% (61) in IVUS, and 46% (34) in OCT (Figure [A]). Subsequently, when surveyed about specific core competencies involved in executing and interpreting these modalities (Figure [B and C]), only 57% (42) reported independence and preparedness for practice in all components of invasive physiology, 15% (11) in IVUS, and 18% (13) in OCT (Figure [D]). Only 7% (5) reported independence in all competencies of all modalities; 53% (39) report independence in all competencies of at least one, but not all modalities; and 40% (30) reported lack of competency-based independence in any modality (Figure [D]. There was no difference between surveys in April 2018 and April 2019 (data not shown).Download figureDownload PowerPointFigure. Competency-based assessment of interventional cardiology fellows' abilities in intracoronary physiology and imaging. A, Percentage of interventional cardiology fellows-in-training (IC-FIT) reporting expert, sufficient, rudimentary, or no exposure in invasive physiology, intravascular ultrasound (IVUS), or optical coherence tomography (OCT) during training. B, Survey questions assessing perceived ability to perform specific competencies involved in executing and interpreting intravascular imaging (IVI) and physiology. C, Percentage of IC-FIT reporting perceived independence, need for assistance, or inability to practice each assessed competency in physiology, IVUS, and OCT. D, Percentage of IC-FIT perceived competency vs competency-based independence by modality. PCI indicates percutaneous coronary intervention.The results of our survey demonstrate that a significant portion of IC-FIT initially reports expert or sufficient experience in intracoronary physiology, IVUS, and OCT. However, among those who report such training, in fact, very few are independent in all components of performance and interpretation required for independent practice.There is a lack of emphasis on intravascular imaging and physiology in national educational guidelines. In 2017 American College of Graduate Medical Education IC fellowship program requirements, "competence in the performance of [intracoronary pressure monitoring… and intravascular ultrasound]" is a requirement without elaboration; OCT is not mentioned.4 In 2015 ACC-COCATS4 (American College of Cardiology - Core Cardiology Training Symposium 4), it is recommended that program faculty include persons competent in intravascular imaging and physiological assessment, but no modality is listed as a procedural skill to be obtained during training.5 This lack of an educational mandate may explain current training that is heterogeneous, dependent on institutional norms, and often inadequate or absent even in university hospitals.Our study was a small 2-year survey from a single educational conference with limited demographic data. Nevertheless, our survey demonstrated that IC-FIT are inadequately trained to perform and interpret intracoronary physiology, IVUS, and OCT independently after their training. The data, methods use in the analysis, and materials used to conduct this research will be made available to any researcher for the purpose of reproducing these results.DisclosuresEvan Shlofmitz is a consultant for Abbott Vascular, Opsens. Mitsuaki Matsumura is a consultant for Terumo Corporation. Dr Kirtane reports institutional funding to Columbia University and/or Cardiovascular Research; foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical. Dr Parikh is a member of the advisory board to Abbott, Boston Scientific, Medtronic, and Philips. Dr Parikh reports speakers bureau for Abbott Vascular, Medtronic, Boston Scientific, CSI; also member of the advisory board to Abbott Vascular, Medtronic. Dr Karmpaliotis received honoraria from Abbott Vascular, Boston Scientific, Abiomed. Dr Leon received institutional grant support from Abbott, Boston Scientific, and Medtronic. Dr Jeremias received institutional grant support/consultant from Philips/Volcano and Abbott Vascular. Dr Stone reports speaker honoraria from Terumo, Novartis, and Amaranth; consultant to Shockwave, Valfix, TherOx, Reva, Vascular Dynamics, Robocath, Gore, Ablative Solutions, Matrizyme, Miracor, Neovasc, V-wave, Abiomed, Claret, Sirtex, Ancora, MAIA Pharmaceuticals, Spectrawave, Orchestra Biomed, Qool Therapeutics; equity/options in Qool Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, MedFocus family of funds, Spectrawave, Orchestra Biomed, Aria, and Ancora. Dr Maehara received grant support from Abbott Vascular and Boston Scientific, consultant for Conavi Medical Inc. Dr Mintz reports honoraria from Boston Scientific, Philips, and Terumo. Dr Ali received institutional research grants to Columbia University, Abbott, Cardiovascular Systems Inc; consultant of Abbott, Medtronic, Boston Scientific, Opsens, AstraZeneca. The other authors report no conflicts.FootnotesFor Sources of Funding and Disclosures, see page 2.Correspondence to: Ziad A. Ali, MD, DPhil, Columbia University Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019. Email [email protected]eduReferences1. Buccheri S, Franchina G, Romano S, Puglisi S, Venuti G, D'Arrigo P, Francaviglia B, Scalia M, Condorelli A, Barbanti M, et al. Clinical outcomes following intravascular imaging-guided versus coronary angiography-guided percutaneous coronary intervention with stent implantation: a systematic review and bayesian network meta-analysis of 31 Studies and 17,882 patients.JACC Cardiovasc Interv. 2017; 10:2488–2498. doi: 10.1016/j.jcin.2017.08.051CrossrefMedlineGoogle Scholar2. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJet al; ESC Scientific Document Group. 2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J. 2019; 40:87–165. doi: 10.1093/eurheartj/ehy394CrossrefMedlineGoogle Scholar3. Koskinas KC, Nakamura M, Räber L, Colleran R, Kadota K, Capodanno D, Wijns W, Akasaka T, Valgimigli M, Guagliumi G, et al. Current use of intracoronary imaging in interventional practice - results of a European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Japanese Association of Cardiovascular Interventions and Therapeutics (CVIT) clinical practice survey.Circ J. 2018; 82:1360–1368. doi: 10.1253/circj.CJ-17-1144MedlineGoogle Scholar4. Accreditation Council for Graduate Medical Education (ACGME). ACGME Program Requirements for Graduate Medical Educationin Interventional Cardiology (Subspecialty of Internal Medicine).https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/152_InterventionalCardiology_2019_TCC.pdf. Published 2019. Accessed November 21, 2019.Google Scholar5. King SB, Babb JD, Bates ER, Crawford MH, Dangas GD, Voeltz MD, White CJ. COCATS 4 task force 10: Training in cardiac catheterization.J Am Coll Cardiol. 2015; 65:1844–1853. doi: 10.1016/j.jacc.2015.03.026CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Jeremias A, Nijjer S, Davies J and DiMario C (2022) Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory Interventional Cardiology, 10.1002/9781119697367.ch7, (75-92), Online publication date: 3-Jun-2022. Shlofmitz E and Busch J (2022) Recognition of Drift: A Key to Success With Invasive Physiology, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2021.11.037, 35, (57-58), Online publication date: 1-Feb-2022. Gogia S, Edens M, Fall K, Petrossian G, Horst J, Jas Garcia J, Ozdemir D, Karimi Galougahi K, Karmpaliotis D, Kirtane A, Ben-Yehuda O, Maehara A, Mintz G and Ali Z (2022) Temporal trends of invasive physiologic assessment of coronary artery stenosis severity: insights from a quaternary care center in the United States, Coronary Artery Disease, 10.1097/MCA.0000000000001137, Publish Ahead of Print Saito Y, Kobayashi Y, Fujii K, Sonoda S, Tsujita K, Hibi K, Morino Y, Okura H, Ikari Y and Honye J (2021) Clinical expert consensus document on intravascular ultrasound from the Japanese Association of Cardiovascular Intervention and Therapeutics (2021), Cardiovascular Intervention and Therapeutics, 10.1007/s12928-021-00824-0, 37:1, (40-51), Online publication date: 1-Jan-2022. Sung J, Sharkawi M, Shah P, Croce K and Bergmark B (2021) Integrating Intracoronary Imaging into PCI Workflow and Catheterization Laboratory Culture, Current Cardiovascular Imaging Reports, 10.1007/s12410-021-09556-4, 14:6, Online publication date: 1-Jun-2021. Shah K and Cohen D (2021) Why Is Intravascular Ultrasound Guidance Underutilized in Percutaneous Coronary Intervention?: It Is Not "All About the Benjamins", Circulation: Cardiovascular Quality and Outcomes, 14:5, Online publication date: 1-May-2021.Shlofmitz E, Ali Z, Maehara A, Mintz G, Shlofmitz R and Jeremias A (2020) Intravascular Imaging-Guided Percutaneous Coronary Intervention, Circulation: Cardiovascular Interventions, 13:12, Online publication date: 1-Dec-2020. Shlofmitz E, Khalid N and Hashim H (2020) Seeing Is Believing: Imaging-Guided Treatment of Calcified Lesions, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2020.07.004, 21:9, (1106-1107), Online publication date: 1-Sep-2020. Truesdell A, Khuddus M, Martinez S and Shlofmitz E (2020) Calcified Lesion Assessment and Intervention in Complex Percutaneous Coronary Intervention: Overview of Angioplasty, Atherectomy, and Lithotripsy, US Cardiology Review, 10.15420/usc.2020.16, 14 Mintz G (2020) Back to the Future, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2020.04.042, 13:12, (1458-1459), Online publication date: 1-Jun-2020. Ali Z and Mintz G (2020) Intravascular Imaging, JACC: Case Reports, 10.1016/j.jaccas.2020.01.022, 2:3, (516-517), Online publication date: 1-Mar-2020. Rao S (2020) Proficiency Divide, Circulation: Cardiovascular Interventions, 13:2, Online publication date: 1-Feb-2020. February 2020Vol 13, Issue 2 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.119.008760PMID: 31973554 Originally publishedJanuary 24, 2020 Keywordscoronary angiographytomographypercutaneous coronary interventionstentscardiologyPDF download Advertisement SubjectsImagingOptical Coherence Tomography (OCT)Ultrasound