Five Questions with Dr. Margaret McEntegart, Head of Complex Coronary Interventions
We spoke with Margaret McEntegart, MD, PhD, about joining the faculty at Columbia—including her role as the head of the Complex PCI and CTO service and about returning to Columbia, where she was an interventional cardiology fellow over 10 years ago.
How did you find your way to Columbia?
It’s actually my return to Columbia; I did an interventional cardiology fellowship with Columbia/NewYork-Presbyterian from 2010–2011. I went to medical school in Glasgow, Scotland, and did my junior training there and Edinburgh. And then I started my cardiology fellowship. But cardiology fellowship there is—like everywhere in the world—very competitive. You usually have to do some academic training.
So I did a PhD at the University of Glasgow while still doing some clinical practice at the same time. And that got me really interested in the whole combination of clinical and academic work, which is one of the fantastic things about cardiology. It's the most evidence-based specialty in all of medicine; every decision we make is based on a study or data, which really appeals to me.
Then I went back and finished my cardiology fellowship. By that point I had decided I wanted to be an interventional cardiologist. So I did an interventional cardiology fellowship in the UK, and then I went to Columbia/NewYork-Presbyterian for a year and did an interventional fellowship there from 2010–2011.
After my year in New York, I went back [to the UK] and started as a consultant—or attending, as you would call it. When I was at Columbia, I worked with Jeff Moses and Ajay Kirtane on chronic total occlusion [CTO] and percutaneous coronary intervention [PCI]. So when I came back to the UK, I wanted to set up a complex PCI and CTO service here.
So I put all my energy into that. I've really been building that service over the last 10 years, in addition to developing my academic portfolio as well. About five years ago, I became research lead for interventional cardiology, in charge of all the research that goes through the department.
And then this past summer, Martin Leon [at Columbia] called me to say, “Would you think about coming back?”
COVID delayed things a bit, but in September I was able to come visit and meet with everybody and see what the situation was. And I agreed to come over as the director of CTO and complex PCI.
I’ll be overseeing the complex PCI service and the CTO cases. I’ll lead the CTO work but I’ll also collaborate with the rest of the faculty in the department and try to support the whole complex PCI service. Also, I plan to support the development of the younger faculty, to mentor and train the younger folks coming through with all the latest techniques and the technologies.
I think there's going to be plenty for me to do. It’s going to be an interesting challenge, and I'm looking forward to it. I want to be a strong presence on the floor. I think, because of COVID, it's been difficult everywhere. I hope to provide an injection of fresh energy and a new perspective, do my part to lift things and help drive everything forward. So hopefully I’m up to the challenge. But I’m excited for it.
What are the differences in practicing here and in the UK?
One of the interesting things about interventional cardiology is the solid global consensus about what we do. I think a lot of that is because the evidence base is so strong—so much research and literature that is global and international—that the practice around the world is quite similar. The main differences I suppose, are more so in the health care systems. When everything is provided through the national health services, there are pros to that in the sense that the idea is meant to be an equal service for everyone. But the downside is there can be a lot of fiscal challenges. Innovation and new technologies can be quite a fight; to try and get to do things that are new and to get support to develop services can be a challenge.
I found that striking. In my experience, the institutional aspirations in the U.S. are quite different than in the UK. I suppose at this stage in my career, 10 years in, it's nice to move toward that approach. For all the fantastic things about a nationalized health service, it can be frustrating at times: when you feel that there are things we could be doing better and you're having problems trying to facilitate that.
Where do you see the field of PCI and CTO heading?
Over the last 10 years, there's been a lot of development for techniques and specific technologies around CTO. But more recently, there's been a lot of development around using imaging in the corners to optimize results: measuring complex physiological parameters and how the artery responds to what you do, using ultrasound or optical coherence tomography (OCT) inside the artery to really assess the result that you achieve.
And there's now a lot of data to support using those assessments and how they correlate with the long-term outcome for the patient. So the focus will be on not only fixing the problem and walking away but actually knowing you've achieved certain specific targets that can predict a better long-term outcome for that patient.
There's been this strive for PCI to become equivalent to bypass surgery. And we've really been working toward that over the last 30 years. I have this thing I always say in these conversations: “If we went back 40, 50 years and switched it so that PCI came first, we would never do as much bypass surgery as we do.” Because when you look at the marginal differences between the two treatments, they're so close now that it'd be very difficult to justify if bypass came along as a new thing, except for in a very small number of people.
What made you choose interventional cardiology?
When I was doing my internship in the residency, right at the beginning of a medical career, I thought I wanted to be a surgeon—I loved to do practical things. So I was going to apply for the surgical training path. And my sister—who's a physician and about six years ahead of me in training—was finishing her training as a rheumatologist and was about to become an attending. And she said to me, “No, you shouldn't be a surgeon. You should be a physician.”
I'm not sure if this is the same in the U.S., but certainly when I was training there was a real culture where the surgeons were thought of almost like the jocks—they're all rugby players—and the physicians were all much more cerebral [laughs].
So she said to me, “Why don't you apply for both?” She knew the physician training interviews were first. “And if you get the physician one, do the physician one for a year. And if you don't like it, you'll still go on the surgical program; you can always switch. But if you go to surgery, you've gone to the dark side, you know?” So she persuaded me to apply and interview for it. There were 200 applications for five posts or so. But I got it.
So I started my physician training and in the first year, I did cardiology. I thought, So I can be academic and I can do something practical as well! I saw that this was going to be the perfect balance, that I could do something that was halfway between the two.
And then as soon as I started cardiology, I immediately gravitated toward the cath lab. I knew straight away that was what I wanted to do. There was no looking back.
Is there anything you’d like to change about the field?
During my training, it amazed me that there was only one female cardiologist in the city at the time. In those days, cardiologists did lots of things. So she put in pacemakers, she did all sorts of work, and she did one day a week in the cath lab. So I kind of tied myself to her for my first big mentorship.
I then became the only female interventional cardiologist in Scotland and was for eight years. I did feel quite a lot of responsibility to try and address that, to contribute to trying to change that. It's interesting because in the UK, out of all the professions in medicine and surgery, including orthopedic surgery and cardiac surgery, the smallest proportion of women is in interventional cardiology. Less than 5% of interventional cardiologists in the UK are women.
That's one of the things that my role at Columbia can help with, providing a bigger platform to try and influence that, to try and drive some change in terms of the proportion of women in interventional cardiology. I'll be able to encourage more trainees and more young women to take up an interventional cardiologist as a career.
Bonus Question: What do you do when you’re not being an interventional cardiologist?
I like to keep fit. Where I live now in Glasgow, we're 20 minutes from the mountains. I tend to hike a lot, sometimes running in the hills. I've got a dog, so lots of hill walks with my dog. Also, I'm quite a keen cyclist; I cycle to work every day and back, And I do a little bit of running and swimming as well; I'm not so sure how easy swimming might be in New York.
I started going to yoga when I was in fellowship in New York, so New York introduced me to yoga. When I arrived for my fellowship, I had achilles tendinitis and I couldn't run. Somebody told me you should go to yoga to fix it. So I started going to yoga and sure enough, it did fix it. It’s been the best thing for me. I've practiced yoga consistently for the 10 years since.
Interventional cardiology is quite a physical job. You have to wear heavy lead coats for long stretches. It’s notoriously bad for orthopedic problems, especially the back. And I've had one or two episodes, with my neck and my back, but the yoga's done an amazing job for me.
Other than staying fit, I’m an avid reader, and in pre-COVID times, the theater and the cinema would be how I'd spend my time at the weekend. I've got a huge family, so there’s always lots going on there as well.