Anthony Hilliard

Challenges facing early career academic cardiologists

Early career academic cardiologists currently face unprecedented challenges that threaten a highly valued career path. A team consisting of early career professionals and senior leadership members of American College of Cardiology completed this white paper to inform the cardiovascular medicine profession regarding the plight of early career cardiologists and to suggest possible solutions. This paper includes: 1) definition of categories of early career academic cardiologists; 2) general challenges to all categories and specific challenges to each category; 3) obstacles as identified by a survey of current early career members of the American College of Cardiology; 4) major reasons for the failure of physician-scientists to receive funding from National Institute of Health/National Heart Lung and Blood Institute career development grants; 5) potential solutions; and 6) a call to action with specific recommendations.

The Importance of Global Health Experiences in the Development of New Cardiologists

As the global burden of cardiovascular disease continues to increase worldwide, nurturing the development of early-career cardiologists interested in global health is essential to create a cadre of providers with the skill set to prevent and treat cardiovascular diseases in international settings. As such, interest in global health has increased among cardiology trainees and early-career cardiologists over the past decade. International clinical and research experiences abroad present an additional opportunity for growth and development beyond traditional cardiovascular training. We describe the American College of Cardiology International Cardiovascular Exchange Database, a new resource for cardiologists interested in pursuing short-term clinical exchange opportunities abroad, and report some of the benefits and challengesxa0of global health cardiovascular training in both resource-limited and resource-abundant settings.

The Association of Previous Revascularization With In-Hospital Outcomes in Acute Myocardial Infarction Patients: Results From the National Cardiovascular Data Registry

OBJECTIVESnThe aim of this study was to compare outcomes of ST-segment elevation myocardial infarction (STEMI) patients with a history of coronary artery bypass graft surgery (CABG), previous percutaneous coronary intervention (PCI), or no previous revascularization undergoing primary PCI.nnnBACKGROUNDnLimited data exist regarding door-to-balloon times and clinical outcomes of STEMI patients with a history of CABG or PCI undergoing primary PCI.nnnMETHODSnWe examined 15,628 STEMI patients who underwent primary PCI at 297 sites in the United States. We used multivariable logistic regression analyses to compare door-to-balloon time delays >90 min and in-hospital major adverse cardiovascular or cerebrovascular events (MACCE).nnnRESULTSnPatients with previous CABG were significantly older and more likely to have multiple comorbidities (p < 0.0001). Previous CABG was associated with a lower likelihood of a door-to-balloon time ≤90 min compared with patients with no previous revascularization. However, no significant differences in door-to-balloon times were noted between patients with previous PCI and those without previous revascularization. The unadjusted MACCE risk was significantly higher in patients with a history of CABG compared with patients without previous revascularization (odds ratio: 1.68, 95% confidence interval: 1.23 to 2.31). However, after multivariable risk adjustment, there were no significant differences in MACCE risk between the 2 groups. No significant differences in in-hospital outcomes were seen in patients with a previous PCI and those without previous revascularization.nnnCONCLUSIONSnIn a large cohort of STEMI patients undergoing primary PCI, patients with previous CABG were more likely to have reperfusion delays, yet risk-adjusted, in-hospital outcomes were similar to those without previous revascularization. No significant differences in reperfusion timeliness and in-hospital outcomes were seen in patients with a history of PCI compared with patients without previous revascularization.

A practical guide to cardiovascular 3D printing in clinical practice: Overview and examples

The advent of more advanced 3D image processing, reconstruction, and a variety of three-dimensional (3D) printing technologies using different materials has made rapid and fairly affordable anatomically accurate models much more achievable. These models show great promise in facilitating procedural and surgical planning for complex congenital and structural heart disease. Refinements in 3D printing technology lend itself to advanced applications in the fields of bio-printing, hemodynamic modeling, and implantable devices. As a novel technology with a large variability in software, processing tools and printing techniques, there is not a standardized method by which a clinician can go from an imaging data-set to a complete model. Furthermore, anatomy of interest and how the model is used can determine the most appropriate technology. In this over-view we discuss, from the standpoint of a clinical professional, image acquisition, processing, and segmentation by which a printable file is created. We then review the various printing technologies, advantages and disadvantages when printing the completed model file, and describe clinical scenarios where 3D printing can be utilized to address therapeutic challenges.

Functional assessment of anomalous right coronary artery using fractional flow reserve: An Innovative Modality to Guide Patient Management.

Anomalous origin of a coronary artery is a recognized cause of sudden cardiac death (SCD). To date, there is no standard test to predict which patients are at increased risk for SCD. Fractional flow reserve (FFR) is an invasive technique used to qualify focal obstructive coronary lesions. We present a case where FFR was used to guide therapy in a young patient with anomalous right coronary artery (ARCA) when standard noninvasive testing showed ischemic discrepancy.

Factors Affecting Time to Presentation in ST-Elevation Myocardial Infarction(FAT STEMI)

Introduction: Advancements in ST-Elevation Myocardial Infarction (STEMI) management have led to improved outcomes and decreased mortality in recent decades. A critical factor in this improvement was developing hospital systems to decrease emergency room door to cath lab balloon times of less than 90 minutes. Continued efforts to decrease total ischemic time by reducing time to presentation are an area for further improvement. Identifying factors that affect the time from the onset of symptoms to presentation can provide hospital systems additional opportunities to improve outcomes of STEMI patients. nMethods: Utilizing a single center, retrospective chart review, 604 STEMI activations were identified. After false activations were excluded, the remaining 529 patient cases were analyzed for various factors and variables affecting the time to presentation (TTP), including age, mode of transportation, race, language, and diabetic status. nResults: The variables found to be statistically significant with their effect on time to presentation to the hospital included race (p=0.024), mode of transportation (p=0.021), and diabetic status (p=0.0054). Additionally for every unit increase in Hgb A1c, TTP increased 1.12 minutes (R2=0.49). Time to presentation showed no statistically significant difference based on age (p=0.60), sex (p=0.15), ethnicity (p=0.46), language (p=0.20) or religion (p=0.15). nConclusions: Mode of transportation, race, and diabetes status had a significant impact on the time from the onset of symptoms to presentation in patients with STEMI. The use of EMS decreases the time to presentation compared to self-transport. Patients, who identify themselves in the “Other” race category, including American Indians, Pacific Islanders, and Native Hawaiians, exhibited longer TTP. Diabetics took longer to present than their non-diabetic counterparts. Interestingly, no differences in TTP were found when comparing age, sex, ethnicity (Hispanic vs. non-Hispanic), language or religion.

Rapid Resolution of Coronary Artery Spasm Complicated by AcuteSystolic Heart Failure with Antirejection Therapy in Acute OrthotopicHeart Transplant Rejection

We report a case of rapid resolution of Coronary Artery Spasm (CAS) and improvement of systolic heart failure by antirejection therapy with methylprednisolone in the setting of acute Orthotopic Heart Transplant (OHT) rejection. The proposed mechanism of action is reduced microvascular inflammation from steroid therapy resulting in enhanced vasomotor response, resolution of coronary artery spasm, and improved hemodynamic. The case report has treatment implications for patients in acute OHT rejection with coronary artery spasm. Antirejection therapy with steroid may be helpful in treating life threatening cardiac conditions in patients with acute OHT rejection and coronary artery spasm.

IMPACT OF HOSPITAL AND SOCIO-DEMOGRAPHIC FACTORS ON DRUG-ELUTING STENT USE IN THE 2011-2012 MEDICARE COHORT: CHOICES, CHANCES, CHANGES

Prior studies have shown that insurance status plays a major role in the disparities observed in drug eluting stent (DES) use. We sought to assess impact of hospital & socio-demographic factors in patients with Medicare coverage.nnWe linked data from 2011-2012 Medicare Inpatient Discharges, Medicare