Interventional cardiology is a rapidly evolving field, offering the opportunity to learn procedures with immediate and life-changing results for patients. This is what has attracted Nieves Gonzalo (Clinico San Carlos University Hospital, Madrid, Spain) to the specialism, and why she believes it will continue to draw in future generations of physicians. Recently appointed as a course director for EuroPCR, Gonzalo also serves as a deputy editor of EuroIntervention, and as a co-chair of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Scientific Documents and Initiatives Committee. She tells Cardiovascular News about her career to date, research priorities, and the importance of representation.
Why did you choose to become a doctor and why, in particular, did you choose to specialise in interventional cardiology?
When I was in high school I loved biology and I was fascinated by the complexity of interactions that allow life to exist. Medicine was the perfect opportunity to continue learning about this and to apply this knowledge to improve lives. I decided to study cardiology because I found heart physiology enthralling and the specialty provided so many opportunities from diagnosis to treatment, and from the beginning, interventional cardiology was the choice for me. The possibility of performing a procedure that generates immediate results for the patient—for example primary percutaneous coronary intervention (PCI)—is extremely rewarding.
Who were the biggest influences on your early career?
I did my cardiology training at Hospital Clinico San Carlos (Madrid, Spain) and all of my colleagues in the interventional cardiology department were extremely supportive. The chief of interventional cardiology at that moment was a woman—Rosana Hernández—and she was a great inspiration. My mentor Javier Escaned, together with Manel Sabate, encouraged me to go abroad for a fellowship at the Thoraxcenter in Rotterdam (The Netherlands) with Patrick Serruys and this widened my view, helping me to incorporate research as a central aspect of my career. In Rotterdam, I worked very closely with Evelyn Regar to develop my thesis on optical coherence tomography (OCT) when the technique was starting out.
What has been the most important development in interventional cardiology during your career?
The most important developments in interventional cardiology during my career have been the incorporation of primary PCI (a lifesaving strategy), the invention of drug-eluting stents (DES) that have tremendously improved the long-term success of PCI, and the incorporation of intracoronary physiology and imaging techniques that have changed the way in which we perform PCI, providing a new insight into the pathophysiology of coronary heart disease. The other big development has been transcatheter aortic valve implantation (TAVI), another lifesaving procedure that has provided a new opportunity for many patients who did not have options before and is contributing to offer less invasive treatments for
What has been the biggest technological disappointment?
The biggest disappointment for me was polymeric bioresorbable scaffolds. I worked intensively on the initial phase of the ABSORB studies during my fellowship in Rotterdam and the initial results were promising. We were all thrilled with the possibility of treating atherosclerotic disease without the need for a permanent metallic cage, it was a pity when larger trials revealed significant problems that precluded their clinical application. I still hope, however, that the concept will be revived. There are so many potential advantages for the future, especially with an ageing population that will probably require repeated interventions throughout their lives.
What are your current research priorities?
My current research priorities are focused on treatment of complex coronary disease, a growing problem as we treat older patients with multiple comorbidities. In this regard, strategies to improve treatment of calcific lesions are going to be key to improve the long-term results of our interventions. I am also very interested in the treatment of restenosis, which is much more challenging in the context of DES, especially with the development of neoatherosclerosis. Another field of interest and research is the relation between physiology and atherosclerotic plaque morphology and the treatment of left main disease.
What are the key unanswered questions around the field that future research should prioritise?
There is currently a renewed interest in the search for high-risk plaques to be able to detect them before they rupture and generate an event. I think this is an important field where intracoronary imaging techniques and potentially non-invasive imaging technologies can provide new insights and help us move toward preventing events instead of treating them. The incorporation of artificial intelligence (AI) will probably be important, especially in plaque characterisation and development of new physiological indices derived from invasive and non-invasive technologies. PCI guidance based on physiology, and imaging and impact on future events as compared with other treatment strategies, is another important area to be addressed. The concept of leaving nothing behind when treating coronary disease—either with bioresorbable devices or drug coated balloons—will also be relevant in future research.
What has been the most important paper published in the past year?
One of the most interesting papers published in the last year for me has been the long-term results of SYNTAX II. The paper demonstrated that applying a complete contemporary percutaneous revascularisation strategy incorporating heart team discussion, imaging and physiology to guide and optimise PCI can yield optimal clinical results in multivessel disease, making it competitive with more invasive strategies.
What are the current challenges facing women seeking to enter the interventional cardiology field, and how can these be overcome?
There are many challenges that women face when they decide to pursue a career in interventional cardiology ranging from the lack of role models and support to concerns regarding pregnancy and reconciliation of family and work life. Big efforts have been made in recent years to generate guidance to overcome these barriers and promote the incorporation of women in leading positions and I am sure they will take effect in the next generation. Promoting a meritocratic system in which gender is not an issue will bring more women into the field and will help them to reach leading roles. Equal representation in research and education is also an important aspect that needs to be considered and properly promoted.
What can interventional cardiology do to better attract young physicians into the field?
The best way to attract young physicians is to show them how fascinating this specialty is. Interventional cardiology is in continuous evolution, meaning that you always keep learning and it is impossible to get bored. From a personal point of view, it is demanding but also really rewarding, offering you a lot of options to help patients. Promoting enthusiastic young colleagues and generating a good working environment for the future is a task for every one of us.
Looking back over your career, what has been your most memorable case?
There are many cases that have been memorable especially, for example, my first case of a patient with a left main occlusion who arrived in a critical situation and was able to survive and recover after primary PCI. There is another case that we performed recently that was also transformative for me. This involved a lady with advanced renal disease, severe peripheral disease with no conventional accesses, critical left main disease with extreme calcification and very severe left ventricular (LV) function. In this case, after careful planning with computed tomography (CT) and with the help of the vascular surgeon, we were able to perform the PCI with LV support through a surgical left subclavian access that was the only route available. For me it was an example of how teamwork is going to be critical in the future as we tackle more and more complex patients and disease.
Outside of medicine, what are your hobbies and interests?
I like nature and outdoor activities. Taking care of my garden is especially relaxing for me. Also, doing exercise is essential to keep me happy. I especially enjoy spending time with my children and share with them my love for music and books.
Appointments and training
Director Consultant Interventional Cardiologist, Clinico San Carlos University Hospital, Madrid, Spain
Fellowship, Thoraxcenter, Erasmus University Rotterdam, Rotterdam, The Netherlands
Doctor of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
European Society of Cardiology (ESC)
European Association of Percutaneous Cardiovascular Interventions (EAPCI)
RIBS IV and V OCT sub-study
Deputy Editor, EuroIntervention
EuroPCR Course Director
Co-chair, EAPCI Scientific Documents and Initiatives Committee