The Skinny on Interventional Cardiology with Dr. Celina Yong!
Welcome back to this month’s MedscapeLIVE! Cardiology E-News. This month I speak with Dr. Celina Yong, Associate Professor at the Stanford School of Medicine and Director of Interventional Cardiology at the Palo Alto VA Medical Center. As Founder and Director of the Stanford Advancement of Women in Medicine Program, and Co-Founder and Co-Director of the CA ACC Early Career Leadership Forum, she has very insightful and informed perspectives on a number of critical issues.
We discussed:
- The growth of female clinicians in cardiology and the role of associations and academic institutions in helping them
- The ACC/AHA/SCAI Training Statement she co-authored in JACC
- What she thinks the community of cardiologists should focus on accomplishing as a group
- Her recent CCI article Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex.
- Her critical insights into the most notable updates to practice per the latest recommendations in the new ACC/AHA/SCAI Coronary Revascularization Guidelines that she highlighted last month in her talk at ACC—get current!
Also check out this issue’s Pulse, with articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine.
Housekeeping: CME 2023—Add this to your calendar now and sign up for updates:
Going Back to the Heart of Cardiology Conference (4th Annual)
Saturday-Monday December 8-10, 2023; Anaheim, California
To register, click here!
Sessions 1-6: Cardiopulmonary Failure; Atherosclerosis and Thrombosis; and Cardiometabolic Disease; Electrical Failure; Valvular Disease: Special Topics in Cardiology
View Faculty & Agenda: https://www.heartofcardio.com/#home-agenda
Thank you to Dr. Yong for her time and expertise as faculty and in this interview. Don’t forget to register here for Medscape’s 2023 Going Back to the Heart of Cardiology conference for the best 2023 CME opportunity available! Please contact me at colleen@cmhadvisors.com with any comments and/or suggestions! –Colleen Hutchinson
The Skinny on Interventional Cardiology with Dr. Celina Yong
Dr. Yong is an Associate Professor at the Stanford School of Medicine and Director of Interventional Cardiology at the Palo Alto VA Medical Center. She is Founder and Director of the Stanford Advancement of Women in Medicine Program, Co-Founder and Co-Director of the CA ACC Early Career Leadership Forum and serves as Co-Editor for the JACC FIT/EC Section.
Colleen: Can you tell us a little bit about the ACC/AHA/SCAI Training Statement you co-authored that was recently published in the Journal of the American College of Cardiology?
Dr. Yong: Yes! Over the last 2 decades, the field of interventional cardiology has completely transformed across the entire spectrum of coronary, structural, and peripheral interventions. We felt there was a need to comprehensively address the breadth of training required to develop competency in these areas – which we’ve done for the first time in this new statement. Some notable highlights – in addition to the required 250 cardiovascular interventions, we now also recommend 25 coronary physiology and 25 intravascular imaging studies to better align training goals with the new guidelines. Among the 250 total interventions required, only 200 must be PCIs, with the other 50 encompassing coronary, structural, or peripheral interventions at the trainee’s discretion. Additional specific numbers associated with structural and peripheral intervention are competency based, rather than time based. My personal hope is that this flexibility may encourage underrepresented IC trainees, including women who may be balancing family planning during these training years, to plan their training around competency rather than a specific time requirement. Ultimately, we hope these building blocks will set the stage for a lifetime of learning in our constantly-evolving field, and over time, competency will grow to proficiency and even mastery.
Colleen: How would you characterize the growth of female clinicians in cardiology? And the role of associations and academic institutions in helping them with leadership positions and research opportunities?
Dr. Yong: The recent changes in our field are palpable - thanks to strong professional association leadership – like Dr. Bob Harrington’s commitment to no “man-els” – to professional society sponsorship of innovative diversity initiatives like the ACC’s Clinical Trial Research program – to academic institutions adopting transparent salary and promotion practices. Unfortunately, we haven’t seen direct translations to all areas of the profession just yet. For example, in my specialty, women constitute only 4.5% of practicing interventional cardiologists in the United States. In a national ACC/SCAI survey, we identified barriers ranging from radiation exposure during child-bearing years to the “old boys club” culture. And when we looked at the last decade of clinical trials* in the United States, we found no improvement in the low proportion of women PIs over time. My hope is that these persistent inequities reflect a lag in the growing pipeline, and that with continued efforts, we will see translation.
- Yong CM, et al. Temporal Trends in Gender of Principal Investigators and Patients in Cardiovascular Clinical Trials. J Am Coll Cardiol. 2023 January 31;81(4):428-430.
- Yong CM, et al. Temporal Trends in the Proportion of Women Physician Speakers at Major Cardiovascular Conferences. Circulation. 2021 Feb 16;143(7):755-757.
- Yong CM, et al. ACC WIC; SCAI WIN. Sex Differences in the Pursuit of Interventional Cardiology as a Subspecialty among Cardiovascular Fellows-in-Training. JACC Cardiovasc Interv. 2019 Feb 11;12(3):219-228.
Colleen: With February being American Heart Month, what do you think this community of cardiologists should focus on accomplishing as a group, in light of the current challenges we face on a global health level?
Dr. Yong: It has been clear for a long time that health doesn’t happen in the hospital. In fact, 60% of premature death is attributable to social determinants of health – which happen almost exclusively outside the hospital. That means that we need to figure out how to reward disease prevention and operationalize equitable care. I love putting in stents, but that’s not the path to improving global health. This is the kind of challenge that can’t be solved alone. It’s going to take the entire community of cardiologists to recognize this, and move together to turn the levers that are actionable.
Colleen: In your recent CCI article, Temporal trends in transcatheter aortic valve replacement use and outcomes by race, ethnicity, and sex, what are the main takeaways?
Dr. Yong: When we looked at over 33 million hospitalizations in the United States from the HCUP database over five years, we found that White patients comprised 65% of all hospitalizations, yet they comprised 83% of the admissions for aortic stenosis – highlighting the fact that we are likely severely underdiagnosing this disease among minorities. Despite tremendous growth in TAVR volumes over the last few years, we’ve also seen the slowest uptake among women and minorities over time. In the last 2 decades, we have developed the most astonishing advances in life-saving innovations in transcatheter therapy, but if we can’t get them to the patients who need them most, it’s not just a lost opportunity -- it is a systemic injustice propagated by our healthcare system.
Colleen: A couple weeks ago at ACC, you highlighted the latest recommendations in the new ACC/AHA/SCAI Coronary Revascularization Guidelines. What are the most notable updates to practice?
Dr. Yong: There are many upgrades from prior recommendations up to Class 1A– ranging from use of the radial artery, functional assessment of indeterminate lesions with FFR or iFR, use of CABG in stable ischemic heart disease with EF<35% to improve survival, and nonculprit PCI in STEMI. There is also a Class 1 recommendation favoring CABG over PCI for left main disease with high complexity CAD. Arguably, the most notable downgrade was a Class 2b recommendation for revascularization to improve survival in 3-vessel disease without left main involvement – down from prior Class 1 for surgery. This was largely driven by the fact that the studies originally showing benefit for surgery were completed in the 1970s and 80s, before our understanding of modern medical therapies. Additionally, the recent ISCHEMIA trial that included more CABG patients than the original surgery studies, showed no overall mortality benefit.
The Pulse
European Heart Journal Article: Thinking outside the black box: CardioPulse takes a look at some of the issues raised by machine learning and artificial intelligence
https://academic.oup.com/eurheartj/article/44/12/1007/6967062
Circulation: Cardiovascular Intervention Review 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
https://www.ahajournals.org/doi/abs/10.1161/HCV.0000000000000088
JAMA Cardiology Original Investigation: Standard vs Augmented Ablation of Paroxysmal Atrial Fibrillation for Reduction of Atrial Fibrillation Recurrence: The AWARE Randomized Clinical Trial
https://jamanetwork.com/journals/jamacardiology/article-abstract/2802860
Cardiology News: LAA closure device shown safe in groups omitted in trials
The 2023 4th Annual Going Back to the Heart of Cardiology:
https://na.eventscloud.com/website/36345/savethedate/
JACC Original Investigation: Changes in Cardiorespiratory Fitness and Survival in Patients With or Without Cardiovascular Disease
https://www.sciencedirect.com/science/article/abs/pii/S0735109723002012
NEJM Perspective: Acute Effects of Coffee Consumption on Health among Ambulatory Adults
https://www.nejm.org/doi/full/10.1056/NEJMoa2204737?query=featured_cardiology
Medical Intelligence Quiz: Cardiac Resynchronization Therapy:
Circulation: Heart Failure Article: Urinary cGMP (Cyclic Guanosine Monophosphate)/BNP (B-Type Natriuretic Peptide) Ratio, Sacubitril/Valsartan, and Outcomes in Heart Failure With Reduced Ejection Fraction: An Analysis of the PARADIGM-HF Trial
https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.122.010111