ABSTRACT
Background: Coronary angiography (CAG) is a fundamental component of cardiology fellowship. As the impact of COVID-19 fueled the need for self-directed and remote learning, we sought to develop a resource that would address this need and improve angiogram interpretation skills among fellows. To this aim we developed a teaching tool correlating fluoroscopic projections with a 3D-printed physical and digital model of coronary anatomy derived from coronary CT. We hypothesized that fellows exposed to this resource would benefit from improved comprehension of spatial concepts in CAG compared to usual resources. Methods: Twenty-two cardiology fellows were randomly assigned to exposure of the teaching tool versus usual resources. An exam assessing comprehension of the spatial orientation of coronary anatomy, aortic cusps, and catheter tip position in relation to fluoroscopic views was administered before and after a six-week exposure period. Scores were compared, and qualitative feedback was obtained using the Likert scale. Results: Fellows exposed to the content achieved a greater improvement on their exam score and were more likely to improve (Figure). All fellows felt the content was superior to existing resources and will improve their comprehension of CAG. Conclusion: Educational platforms leveraging 3D printing can enhance comprehension of CAG among cardiology fellows, and may serve as valuable resources to promote self-directed and remote learning. [Formula presented]
ABSTRACT
Background: The COVID-19 pandemic is associated with delayed revascularization and worse clinical outcomes for patients with ST-Elevation MI (STEMI). The purpose of this study was to evaluate whether a comprehensive STEMI protocol (CSP), which improved door-to-balloon times (D2BT) and mortality prior to the pandemic, mitigated the pandemic's negative effect on STEMI care and outcomes. Methods: We performed a prospective, single-center, registry-based study of 433 patients who received PCI for STEMI though an established CSP. We compared D2BT and in-hospital mortality of the period immediately prior to the pandemic (control period;1/1/19 -3/14/20, N=291) with the period from 3/15/20 to 12/31/20 (study period, N=142), in-line with the declaration of a state of emergency by the state of Ohio. Results: Between control and study period, patients were similar in regards to age (61.2 +/- 12.0 yrs vs. 61.7 +/-13.2 yrs), female sex (32.3% vs 30.3%), nonwhite race (30% vs 26%), smoking status, BMI (30.4 +/- 8.9 vs 29.9 +/- 6.3), and other comorbidities. There was no significant difference in % meeting D2BT goals for STEMI (<=90 minutes for ED and in-hospital, <=120 minutes for hospital transfer patients) during control and study periods (79.0% v 78.9%, p = 0.97). When stratified by STEMI presenting location, there was no significant difference between control and study period D2BT for patients presenting in primary ED (48 min [IQR 36-66] vs 60 min [IQR 42-73], p = 0.09), as hospital transfers (96 min [IQR 79-119] vs 95 min [IQR 80-112], p = 0.86), or from in-hospital locations (95 min [IQR 80-112] vs 95.8 min [IQR 52-120], p = 0.50). There was no significant difference in in-hospital mortality between the control and study periods (4.5% and 2.1%, p = 0.22). Conclusions: Despite the profound effect of pandemic on overall health care operations, there was little overall change in STEMI process and outcome metrics within a high reliability CSP.