Revolutionizing Interventional Cardiology in Ontario

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A new model in interventional cardiology in Ontario has evolved over the last few years, providing prompt diagnosis and treatment of coronary artery disease within days of being admitted.

“Clinical research has shown that for patients with acute chest pain, especially those who are very ill, quicker is better, so in response we built Cath Labs and other resources to accommodate this new paradigm,” says Dr. Eric Cohen, head of the Cardiac Catheterization Laboratory of the Schulich Heart Centre at Sunnybrook and Women’s College Health Sciences Centre. “Major cardiac centers like S&W are obviously important for patients admitted here, but also play a key role in providing timely access to invasive procedures for patients admitted to other hospitals. We are able to transfer and treat patients relatively quickly and efficiently, and maintain good lines of communication with other hospitals. We try to achieve equitable care for all patients, whether at our hospital or at a hospital that lacks tertiary cardiac facilities.

The Schulich Heart Centre at Sunnybrook & Women’s is one of three “full service” cardiac centers (offering diagnostic catheterization, angioplasty, and cardiac surgery) in Toronto, and one of 11 in the province. Seven other hospitals perform only catheterization or catheterization plus angioplasty. All the cardiac hospitals work with the Cardiac Care Network of Ontario to provide timely access to advanced cardiac care to Ontarians.

The interventional cardiology group at Sunnybrook & Women’s has achieved many significant milestones, providing innovative care that leads to safer, more effective, and less invasive interventions than ever before. This innovation is crucial if we are to successfully develop strategies to meet the needs of the growing number of older patients with more complex cardiovascular problems.

Cardiac patients undergo interventional procedures including angioplasty and stent implantation (also known as PCI), sometimes with the aid of intravascular ultrasound, in one of three specialized cardiac laboratories (or “cath labs”) within Sunnybrook & Women’s. The labs provide a sterile procedure environment with state-of-the-art X-ray imaging to guide the procedures. Schulich Heart Centre is one of only a few centres in Ontario that uses a cath lab for implantation of cardiac rhythm devices such as pacemakers and defibrillators. The scheduling flexibility that results from moving these implant procedures out of the traditional operating room decreases the waiting time and improves access for patients requiring specific device implants.

Ongoing and exciting developments at Sunnybrook & Women’s include building of the Imaging Research Centre for Cardiac Intervention. A multi-disciplinary team of researchers from Sunnybrook & Women’s and other University of Toronto hospitals will work to develop and evaluate the latest equipment and methods in cardiac imaging. Made possible through $12 million in grants from the Canada Foundation for Innovation and Ontario Innovation Trust, the new research laboratory will be the blueprint for the cardiac intervention suite of the future.

Other important work involves research to evaluate new drugs and devices (such as newer types of stents) for coronary angioplasty. The Interventional Cardiology Research Group at Sunnybrook & Women’s is one of the largest clinical research teams in Canada, employing four full-time research nurses.

The Centre attracts a large number of undergraduate and postgraduate cardiac trainees, both nationally and internationally. Fully qualified cardiologists come to S&W to obtain additional training in specific interventional techniques (“fellowship” training) en route to becoming interventional cardiologists. Each year two or three interventional cardiology fellows work with the staff cardiologists. The permanent interventional cardiology staff has grown substantially, with five new recruits over the past five years.

Although interventional cardiology typically refers to non-surgical coronary artery procedures such as angioplasty, the academic thrust of the Schulich Heart Centre is viewed more broadly as “Interventional Cardiovascular Medicine”. This encompasses not only angioplasty but also less invasive surgical procedures, electrophysiology procedures used to diagnose and treat cardiac rhythm disorders, and gene or cell-based repair of damaged cardiac tissues.

S&W’s partnerships include a strong involvement with the Institute for Clinical Evaluative Sciences and the Imaging Research Group internally, and the Cardiac Care Network externally.

Named in honour of philanthropist and Canadian entrepreneur Mr. Seymour Schulich, the Schulich Heart Centre at Sunnybrook and Women’s College Health Sciences Centre stands as one of Canada’s leading cardiac care centers with an international reputation as a leading-edge provider for the prevention, treatment and care of heart disease. Schulich Heart Centre delivers a full spectrum of in-hospital and ambulatory cardiovascular care, significantly improving the quality of life for patients with heart conditions in Canada.