Cindy Grines is an interventional cardiologist and chief scientific officer of Northside Hospital Cardiovascular Institute, Atlanta, USA. She has recently completed a term as the president of the Society for Cardiovascular Angiography & Interventions (SCAI). During her varied career, she has been involved in clinical trials that have revolutionised the care of ST-elevation myocardial infarction (STEMI) patients worldwide, and is a pioneer of primary percutaneous coronary intervention (PCI) for heart attacks.
Why did you decide to become a doctor and why, in particular, did you choose to specialise in interventional cardiology?
I did not decide to become a doctor until I was near the end of my college career. There were not any physicians in my family, but I had taken a lot of pre-med classes, as that is just what I found interesting. I ended up getting good grades, so it was the other students who talked me into going into medicine—the thought had never crossed my mind! I did cardiology rotations when I was an intern and it was very interesting and I thought you could save a lot of lives. Also, it was never a stagnant field, there were acute breakthroughs constantly. I thought I would be a non-invasive cardiologist based on where I did my general fellowship, but when I went to University of Michigan to do my cardiology fellowship, they were just really into acute myocardial infarction (AMI), thrombolysis and rescue angioplasty at that time and I fell in love with the interventional component and acute care cardiology.
Who have been your career mentors?
When I was a resident at Ohio State University there were a couple of general cardiologists who helped to shape my career—Charlie Wooley and Haris Boudoulas. Then, when I did my cardiology fellowship, I had several mentors. Bill O’Neill, an interventionalist, and Eric Topol, were probably the two that were the most influential in my career.
What has been the most important development in interventional cardiology during your career to date?
I was lucky to be involved in researching the use of primary PCI for STEMI patients. We did the original multicentre trials proving that it was better than thrombolytic therapy, and ultimately were able to change the way those patients are managed worldwide. There are very few coronary interventional procedures that save lives, but primary angioplasty for heart attacks is a huge lifesaver, so I am really thrilled to have been part of that.
The second thing is the use of stents to stabilise vessels so they do not have a high risk of abrupt closure due to dissections. The third thing was the use of TAVI [transcatheter aortic valve implantation]—percutaneous valve replacements—that is a big lifesaver as well.
What has been the biggest disappointment—something you hoped would change practice, but did not?
There have been a lot of renditions of different types of stents—the thinner strut stents are good because they are more flexible and deliverable, and there is less restenosis. But, we have tested all these types of stents, like the bioresorbable scaffolds, the bioresorbable polymers, all those have really not panned out to be advantageous, and that has been a real disappointment. The other thing that is disappointing is the fact that if you look at complex multivessel disease, we are still not as good as bypass surgery in the most complex cases and that has been particularly frustrating to me.
What are your current research interests?
We are still trying to look at the nuances with regard to STEMI care, and trying to get networks available for the National Cardiogenic Shock Initiative. We are working on revising the SCAI shock classification, as well as looking at a lot of different issues with regard to ischaemic heart disease in women, which I think is a very important area. Also, complex coronaries in general and the use of percutaneous support devices.
What are the key unanswered questions around the field that future research should prioritise?
Trying to distinguish which patients absolutely need to have surgery versus angioplasty is one big unanswered question. Secondly, the acute outcomes with angioplasty are always superior to bypass surgery—but it is in the late outcomes where bypass surgery seems to be the big winner. The question is: why is that? What can we do to prevent that—can we do better screening to identify the patients who have restenosis or the presence of vulnerable plaques in areas that have not been treated? Can we apply various medications for that, or can we better analyse those plaques to identify which ones might be prone to plaque rupture?
What has been the main accomplishment during your time as president of the Society for Cardiovascular Angiography and Interventions (SCAI)?
This has been the only year where the president has never had a single face-to-face meeting and everything was virtual! We really beefed up all of our online presence—we had a new website developed, hosted a number of different webinars providing education, and we did all of our Scientific Sessions meetings virtually. This has allowed us to expand greatly overseas, with a lot more presence in China and India in particular, but also several other countries. We have also completely revamped our strategic plan, and we are trying to turn SCAI into a more flexible organisation, to be able to react more quickly.
With regard to the pandemic, we have produced white papers and recommendations, and have started a couple of registries, including the North American Cardiovascular COVID-19 Myocardial Infarction (NACMI) registry just published recently.
Being only the third woman ever in the history of SCAI to be president, I made it my goal to try to expand diversity, equity, and inclusion and so we developed a brand new committee in that regard. We also completed a white paper looking at disparities in the diagnosis, management, and treatment and outcomes among any type of interventional disease. This covered coronary artery disease, peripheral disease, structural heart disease, and congenital defects. We pulled together lots of different people, all interventional cardiologists from different disciplines to identify disparities and care gaps, and make recommendations about what we should do.
How has the COVID-19 pandemic impacted the field of interventional cardiology?
The main impact has been the withholding of care. We noticed very early on, after the recommendations for people to stay at home, that there was a 40% drop in patients coming to the hospital with heart attacks. Subsequently, there was a huge increase in out-of-hospital-cardiac arrests, and deaths occurring at home. Obviously, patients needed to be told to not go out and socialise but the message was not there for them to continue to seek medical care if they had symptoms, and I think that is a travesty to not have thought about that in advance. In SCAI, we conducted a survey of consumers to find out what their concerns were, and we developed a campaign called ‘Seconds Still Count’. I am not sure that it is 100% back to normal yet, but it has been wildly successful at trying to get them back to hospital.
What advice would you give to someone looking to start a career in medicine?
I think that we definitely need more bright minds in cardiology. A lot of medical students seem to be more into the lifestyle, and they are going into professions that are perceived to be easier. Unfortunately, those may not be as interesting as cardiology. You have to look at the big picture: what is your career going to look like in 30 years? Secondly, what is the level of satisfaction? In cardiology, it is great because you know you are making a huge difference in these patients, you are saving lives on a daily basis. Not only that, on a daily basis there is something new and exciting that is happening, so there is no way that you are ever going to get bored in cardiology.
What can cardiology do to better attract young physicians into the field?
I think the biggest detriment is the time required to get to that end goal. If I want to be an interventional cardiologist, I have to do four years of college, I have to do four years of medical school, I have to do three years of internal medicine, three years of general cardiology, then one to two years of interventional cardiology. That is a big problem, and many people do not want to wait that long. I think that if we could get cardiology out from underneath internal medicine and have our own specialty that would totally shorten the timeframe required to become a cardiologist, I guarantee there would be a lot more people willing to go into it. The second thing is that medical school does not require cardiology as a rotation—do not ask me why because it is the number one cause of death worldwide!
What are your hobbies and interests outside of medicine?
I am a big explorer. I like to go to different countries and I love the national parks here in the USA. I visit friends, lots of whom are scattered around the country, and also I like to read a lot. Interestingly enough, everybody thinks ‘oh you’re an intellectual!’—but I like to read like mystery stories or historical fiction.
Appointments (selected past and present)
Chief Scientific Officer, Northside Hospital Cardiovascular Institute,
Professor and Chair Cardiology, Zucker School of Medicine at Hofstra/Northwell, New York, USA
Professor of Medicine, Wayne State University, Detroit, USA
Director, Interventional Cardiology Fellowship Program, William Beaumont Hospital, Royal Oak, USA
Society for Cardiovascular Angiography and Interventions
American College of Cardiology
American Heart Association
European Society of Cardiology
Cardiology Fellowship, University of Michigan Hospital, Ann Arbor, USA
Research Fellowship, Internship & Residency, MD Cum Laude, Ohio State University, Columbus, USA
Honours and Awards (selected)
Master Interventionalist of SCAI
American College of Cardiology Distinguished Mentor Award
Devotion to Mentoring Women in the Interventional Cardiology and Improving Outcomes of Patients with Cardiovascular Disease, SCAI
Luminary in Interventional Cardiology, SCAI
American Medical Women’s Association Scholastic Achievement Award