SCAI Interventional Cardiology Board Review – Second Edition
Preparation for a board certification examination is a stressful and demanding process, whether for initial board certification or recertification as required every 10 years for most American Board of Internal Medicine (ABIM) specialists. In many fields, including Interventional Cardiology, the demand is accentuated by the need to review large amounts of material, much of which is rapidly evolving, while working long hours in clinical practice or a training program. The knowledge base required includes an understanding of data that are of historical importance or relate to basic mechanisms as well as those that impact routine clinical decision-making and patient care. There is a requirement to understand the findings of past and contemporary clinical studies that impact clinical practice and to know the latest standards of care that have been compiled into practice guidelines. Thus, there is a clear need for a concise, detailed review tool that is ample in historical and basic material and up to date regarding current evidence.
The Society of Cardiac Angiography and Intervention (SCAI) Interventional Cardiology Board Review, in its second edition, edited by Morton J. Kern, accepts this challenge. The book is not designed as a textbook of Interventional Cardiology with an exhaustive discussion of the field, but as noted in the preface, is designed as a concise yet detailed study guide that attempts to cover all the major topics as provided in the outline describing the ABIM certifying examination. The authors and contributors represent a mixed group of established, seasoned faculty and early career leaders. This adds a composite of experience and freshness that is useful for maintaining a concise discussion that meets the needs of historical perspective and the more contemporary requirements from the standpoint of recent trainees. The book is divided into 9 sections that cover topics ranging from a focused and relevant review of basic science and pharmacology, imaging and coronary physiology, to contemporary practice of coronary, peripheral vascular, and structural heart disease. The chapters are all well written, and the editor has assured consistent style and format throughout. The key points provided at the end of each chapter are especially useful as a quick summary of the topic or perhaps a last minute additional review.
Although the candidate who uses the textbook as a study guide can be confident in the quality of the material and the completeness of the topics covered, there are a number of challenges that should be noted. The most important of these is the basic limitation of any textbook format, especially in a rapidly evolving field such as Interventional Cardiology. Despite a publication date of 2014, some of the material is already outdated. Given an expected durability of 7 years based on the interval between the first and second editions, this is a major concern for subsequent utilization as a study guide. Although this is much less of an issue for basic physiology and disease mechanisms, it is a clear concern for more rapidly evolving areas such as treatment algorithms for ST elevation myocardial infarction and clinical trial outcomes for newer technologies. For example, the chapters on ST elevation myocardial infarction do not include recent data on effect of thrombus aspiration (published in 2012 and 2013), the benefit of radial versus femoral artery access (published in 2012), or the 2013 guideline update.
Another challenge is the balance between having experts as authors and the potential for bias, especially in areas of potential controversy. The authors and editor appear to have avoided the appearance of bias for the most part. Even in chapters discussing specific equipment needs and selection I found that bias and conflicts were apparently avoided. In other topics, such as the treatment of multivessel coronary disease, it was more apparent that an interventional cardiology perspective was taken. A more balanced interpretation based on later outcomes from Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) and Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease (FREEDOM) should indicate that even in lower complexity multi-vessel disease coronary artery bypass surgery is preferred, especially in patients with diabetes.
Finally, the very objective of a concise but complete review poses another major challenge for individual authors and the editor. Here again they have done a very good job of achieving the balance of adequate detail without being too burdensome for the busy examination candidate. For example, the topics related to pathogenesis and disease mechanisms might be considered simplistic to basic scientists, but are clearly accurate and adequate to support the knowledge base of the interventional cardiologist. The chapter on clinical trial statistics is also quite basic, but provides a clear and succinct review of the essentials required for an expert in a field where understanding the validity of the accumulating evidence from clinical research is an important part of the specialty expertise. In most cases, the important individual clinical trials are discussed in detail. This is helpful for review, as the board examination frequently questions specific results of clinical trials. On the other hand, the basic and controversial clinical topics of peri-procedural myocardial infarction and stent thrombosis may have benefited from a more comprehensive presentation, either within the complications or postintervention management chapters.
Aside from the textbook, the review tool also includes access to online content including practice board review questions and answers. The questions selected are helpful learning tools and useful practice for the examination. One wonders whether the online format might also be useful if SCAI wished to provide annual updates of critical material not covered in the text.
In summary, SCAI Interventional Cardiology Board Review, second edition, is a success. Within the limits of a published textbook it meets easily the objectives of a concise yet detailed review to help study for the Interventional Cardiology Board examination. To the extent that the preparation for the board certification examination should really be about improving the knowledge base of the clinician and the quality of care for the patient, the book can be an important part of that process in interventional cardiology. Its limitations do require additional study methods for updated critical changes or new knowledge, but the book forms a solid foundation.
Donald E. Cutlip, MD
Beth Israel Deaconess Medical Center
Cardiology Division, Department of Medicine
Research grant or contract paid to institution: Medtronic, Boston Scientific, Abbott Vascular, Celonova Biosciences, and Tryton Medical.
- © 2014 American Heart Association, Inc.