What is Interventional Cardiology?
Interventional cardiology is a subspecialty of cardiology focused on catheter-based treatments for cardiovascular disease, including coronary artery interventions (angioplasty, stenting), peripheral vascular procedures, and structural heart interventions (valve repairs, defect closures), performed through minimally invasive techniques rather than open surgery. 1
Core Scope of Practice
Interventional cardiologists perform therapeutic procedures using catheter-based techniques to treat:
Coronary artery disease: Percutaneous coronary intervention (PCI) with balloon angioplasty and stent placement for blocked arteries, particularly urgent revascularization for ST-elevation myocardial infarction, unstable angina, and cardiogenic shock 1
Structural heart disease: Transcatheter valve replacement/repair, patent foramen ovale closure for stroke prevention, atrial septal defect closure, left atrial appendage closure for atrial fibrillation patients, and paravalvular leak repair 1
Peripheral vascular disease: Catheter-based treatment of arterial blockages in legs, kidneys, and other non-coronary vessels 1
Complex hemodynamic assessment: Advanced catheterization laboratory evaluation of unexplained dyspnea, prosthetic valve dysfunction, and conditions difficult to assess with echocardiography alone 1
Why Local Cardiologists May Not Provide These Services
General cardiologists typically do not perform interventional procedures because interventional cardiology requires additional specialized fellowship training (1-2 years beyond general cardiology fellowship) with specific procedural volume requirements and board certification. 1
Key distinctions:
Training requirements: Interventional cardiology requires ACGME-accredited fellowship training with minimum procedural volumes, while general cardiologists complete only diagnostic catheterization training 1
Technical expertise: Interventional procedures demand proficiency in complex catheter manipulation, intracoronary imaging (IVUS, OCT), physiologic testing (fractional flow reserve), mechanical support devices, and complication management 1
Facility requirements: Many interventional procedures require specialized equipment, multidisciplinary teams (cardiac surgery backup, imaging specialists), and high-volume centers with specific accreditation 1
When to Seek Interventional Cardiology Consultation
You should request referral to an interventional cardiologist when:
Acute coronary syndromes: Heart attack, unstable angina, or cardiogenic shock requiring urgent catheterization and possible stenting 1
Complex coronary disease: Multivessel disease, chronic total occlusions, or heavily calcified lesions requiring specialized techniques 1
Structural heart conditions: Valvular disease potentially amenable to transcatheter repair, stroke with patent foramen ovale, or atrial fibrillation requiring left atrial appendage closure 1
Peripheral vascular disease: Symptomatic leg claudication or critical limb ischemia from arterial blockages 1
Common Pitfalls
Do not assume all cardiologists perform the same procedures—explicitly ask if your cardiologist performs interventional procedures or if referral to an interventional specialist is needed. 1 Many smaller communities lack interventional cardiology services, requiring transfer to regional centers for complex procedures 1. For structural heart interventions specifically, procedures should be performed at regional centers with qualified specialists and appropriate multidisciplinary teams 1.