interventional cardiology fellowship curriculum - Winthrop University ...

Interventional cardiology is the prototype of a medical field marked by rapid technologic
advances over a short period of time. Current practice of routine stenting and adjunctive
glycoprotein (GP) Ilb/IIIa use has substantially improved patient outcomes over those
obtained in the early years of conventional balloon angioplasty. According to American
Heart Association estimates, percutaneous coronary intervention (PCI) is now performed
in the United States about 926,000 times each year on over one-half million patients.
Despite this astonishing level of adoption into mainstream cardiovascular practice in a
little over a decade, many controversies persist about the appropriate indications for PCI
and about its value provided for money spent.
Specifically, fellows will be exposed to issues surrounding cost effectiveness of
interventional therapy versus medical therapy in a variety of clinical situations. Fellows
will also gain exposure to practice management concerns, including malpractice
insurance, practice development, interaction with referring physicians, and coding of
billable procedures.
Detection of Vulnerable Plaque
Three million Americans develop acute myocardial infarction or unstable angina each
year and present to the hospital alive. Unstable angina, myocardial infarction, and often
sudden cardiac death result from disruption of a vulnerable coronary atherosclerotic
plaque and consequent development of superimposed flow-limiting thrombosis. Recent
advances in our understanding of the structural, cellular, and molecular mechanisms
underlying plaque instability have engendered intense research efforts to detect and
further characterize vulnerable atherosclerotic plaque in vivo. Efforts to identify
atherosclerotic plaque at greater risk of disruption and subsequent thrombosis could
extend our understanding of its pathophysiology permit the application of new or
established therapies directed at patient or lesion vulnerability, and result in primary and
secondary prevention of the acute coronary syndromes.
Fellows will gain exposure and understanding of the number of invasive (i.e., catheterbased)
and noninvasive technologies that quantitatively or qualitatively assess plaque
structure, composition, or function and that are either currently available or under
evaluation.
Percutaneous ASD and PFO Closure
Over the past decade, percutaneous methods of repairing atrial septal defects (ASD) and
patent foramen ovales (PFO) have become available. In the case of the ASD, welldefined
indications for closure/repair have been available for some time. These include
evidence of right heart volume overload and RA or RV dilation, pulmonary hypertension
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