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November 6, 2019

Leveraging the Power of Marginal Gains to Improve Outcomes in Interventional Cardiology

Author Affiliations
  • 1The Cardiac and Vascular Institute, Gainesville, Florida
  • 2The University of Central Florida, Orlando
  • 3Virginia Heart/INOVA Heart and Vascular Institute, Falls Church
  • 4Columbia University Irving Medical Center, New York–Presbyterian Hospital, New York
  • 5Associate Editor, JAMA Cardiology
JAMA Cardiol. 2020;5(2):121-123. doi:10.1001/jamacardio.2019.4278

Success is a few simple disciplines, practiced every day; while failure is simply a few errors in judgment, repeated every day.

Jim Rohn, “This Coach Improved Every Tiny Thing by 1 Percent and Here’s What Happened,” 20181

The advancements in interventional cardiology since Andreas Gruentzig performed the first coronary angioplasty have been remarkable. Major innovations, such as primary percutaneous coronary intervention (PCI), improvements in antithrombotic pharmacology, and the development of coronary stents and drug-eluting technology have resulted in substantial gains in cardiovascular outcomes and were accordingly widely adopted. In years since, there has been continued focus on identifying clinical practices to further improve patient outcomes, albeit with perhaps smaller incremental benefits to patients. Examples include advancements in medical therapy, the adoption of radial artery access, the use of ultrasound guidance for vascular access, and intracoronary physiology and imaging use to guide PCI. However, many cardiologists are slow or resistant to incorporate these and other contemporary practices. At conferences, in hospitals, and on social media, they may reference the “marginal gains” associated with individual practices they perceive to be time-intensive, cost-prohibitive, or unnecessary. But is it possible that in the modern era, a focus on marginal gains is the key to further improving interventional outcomes?