{"id":45327,"date":"2014-09-22T16:05:34","date_gmt":"2014-09-22T20:05:34","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=45327"},"modified":"2014-09-22T16:05:34","modified_gmt":"2014-09-22T20:05:34","slug":"acc-withdraws-choosing-wisely-recommendation-against-revascularization-of-nonculprit-lesions","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/09\/22\/acc-withdraws-choosing-wisely-recommendation-against-revascularization-of-nonculprit-lesions\/","title":{"rendered":"ACC Withdraws &#8216;Choosing Wisely&#8217; Recommendation Against Revascularization of Nonculprit Lesions"},"content":{"rendered":"<p>The American College of Cardiology <a href=\"http:\/\/www.cardiosource.org\/en\/News-Media\/Media-Center\/News-Releases\/2014\/09\/Choosing-Wisely-Statement.aspx\">said<\/a> today that it was withdrawing one of its five recommendations in <a href=\"http:\/\/www.choosingwisely.org\/doctor-patient-lists\/american-college-of-cardiology\/\">the &#8220;Choosing Wisely&#8221; campaign<\/a>. \u00a0In 2012 the ACC recommended that heart attack patients should have only their culprit artery unblocked. It said that patients and caregivers should question whether complete revascularization of all nonculprit lesions in heart attack patients should be performed.<\/p>\n<p>The original recommendation was based on non-randomized studies suggesting that treating all significantly blocked vessels in heart attack patients could be harmful. &#8220;However,&#8221; the ACC now states, &#8220;over the last two years, new science has emerged showing potential improvements for some patients in their overall outcomes as a result of complete revascularization.&#8221;<\/p>\n<p>Two recent randomized controlled trials have altered the field. The 2013\u00a0<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1305520\">PRAMI<\/a> trial and last month&#8217;s <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/news\/new-support-for-complete-revascularization-during-primary-pci\/\">CvLPRIT<\/a> trial offered evidence that stenting all arteries with large blockages improved the outcome of heart attack patients. But the studies, the ACC states, \u00a0left many open\u00a0questions &#8220;about the exact timing of the procedures; whether certain patients benefit versus others; whether FFR might guide decisions; and the role of patient complexity and hemodynamic stability.&#8221;<\/p>\n<p>\u201cScience is not static but rather constantly evolving,\u201d said ACC President Patrick T. O\u2019Gara, in a press release. He said current clinical guidelines and appropriate use criteria recommendations will also address the impact of the trials. The ACC said it plans to update its &#8220;Choosing Wisely&#8221; recommendations.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The American College of Cardiology said today that it was withdrawing one of its five recommendations in the &#8220;Choosing Wisely&#8221; campaign. \u00a0In 2012 the ACC recommended that heart attack patients should have only their culprit artery unblocked. It said that patients and caregivers should question whether complete revascularization of all nonculprit lesions in heart attack [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[431,1201,245,2378,302],"class_list":["post-45327","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-acc","tag-choosing-wisely","tag-mi","tag-nonculprit-lesion","tag-primary-pci"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/45327","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=45327"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/45327\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=45327"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=45327"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=45327"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}