ACC takes revascularization off its ‘beware’ list

The American College of Cardiology (ACC) revised its Choosing Wisely list, removing a recommendation that questioned the necessity of coronary interventions that extend beyond revascularization of a culprit lesion.

The ACC deleted its recommendation based on evidence that showed benefit from complete revascularization of arteries with major stenosis compared with treatment of only the culprit lesion. The ACC cited CvLPRIT (Complete Versus Lesion Only PRimary-PCI Trial) results as well as findings from PRAMI (Preventive Angioplasty in Myocardial Infarction) that found better outcomes with complete revascularization.

“While some questions remain about the exact timing of the procedures; whether certain patients benefit versus others; whether FFR [fractional flow reserve] might guide decisions; and the role of patient complexity and hemodynamic stability, there is additional need for further data across larger populations,” the ACC wrote. It added that trials designed to fill those knowledge gaps are under way.

The ACC published its ABIM Foundation Choosing Wisely list of five recommendations for practices that providers and patients should scrutinize in 2012. The updated list is available here.