It is my distinct pleasure to serve as the Guest Chief Medical Editor for this issue of Cardiac Interventions Today. In this issue, we focus on a frequent obstacle in interventional cardiology—calcium. With a growing aging population and our ability to perform increasingly complex coronary and structural procedures, figuring out how to offer the best outcomes in the face of calcium has become a common scenario in clinical practice. While mitigating calcium later in life remains a future ideal, needing to be facile with recognizing it modifying it, and optimizing our procedures despite it is the current reality. I want to thank all of our contributors for sharing their expertise in helping us to do our jobs better.

We open our Calcium Considerations cover focus with a question: Why is there so much calcium, and can it be prevented? Aman Kansal, MD, and Jennifer Rymer, MD, review primary, secondary, and tertiary approaches to preventing the incidence, progression, and recurrence of atherosclerotic cardiovascular disease and related events. Next, Sarah Malik, MD; Evan Shlofmitz, MD; and Richard A. Shlofmitz, MD, walk us through the essentials of coronary calcium evaluation by exploring the role of invasive and noninvasive imaging assessment.

Harshith Chandrakumar, MBBS; Molly Silkowski, DO; and Anbukarasi Maran, MBBS, discuss calcific coronary lesion imaging and treatment, diving into the pros and cons of the available imaging modalities and modification therapies, plus the importance of a structured, algorithmic approach to management.

It is becoming increasingly important to understand and evaluate the role of calcium in transcatheter valvular therapies. We have engaged experts who share with us their thoughts and approaches when determining how to manage calcium in practice. Megan Coylewright, MD, focuses on considerations regarding calcium in aortic valves and the associated management options to inform shared decision-making. Luke P. Dawson, MBBS, and Rahul P. Sharma, MBBS, explore calcium in mitral valves and provide some understanding of how mitral annular calcification is assessed and how it may influence the outcomes of treatment options.

We wrap our cover focus on calcium with an exploration of access and closure of calcified vessels in patients undergoing PCI. Jacob C. Ricci, MD; Prashant Kaul, MD; and Andrew J. Klein, MD, provide an analysis of access decision points and closure technologies in the setting of arterial calcification.

Elsewhere in this issue, Ahmad Jabri, MD; Anas Alameh, MD; Bryan Kelly, DO; and Vikas Aggarwal, MD, detail a step-by-step approach to balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension. And, in our Today’s Practice column, Nihar R. Desai, MD, and Denise Busman, MSN, RN, explore how a comprehensive approach to improving lipid levels after acute coronary syndrome hospitalization requires early intervention, multidisciplinary collaboration, and engagement with the care team when it comes to workflow changes.

Our Interview With column closes this issue; Faisal Sharif, MD, highlights what “translational cardiovascular medicine” looks like in practice, his work with CURAM and BioInnovate, insights from running an RDN center of excellence, and more.

We hope that you find this issue of Cardiac Interventions Today to be of benefit in both your practice and toolbox.

Jennifer A. Tremmel, MD, MS
Guest Chief Medical Editor