Cardiac Intervention Guidelines Get Update

The American College of Cardiology (ACC) has had a change of heart.

The group is now recommending doctors treating heart attack patients for arterial blockages should treat lesions in both cardiac arteries, not just the “culprit” artery that led to the MI.

In a statement Sept. 22, the ACA cited new information—reported Sept. 5 by HCPLive.com—from a UK study showing that it pays to do the more extensive procedure.

Reporting on a study known as CvLPRIT, principal investigator Anthony Gershlick, MD, said performing PCI to remove lesions in non-involved arteries as well resulted in a 55% reduction in major adverse cardiac events (MACE). The full name of the study is “Complete Versus Lesion only Primary-PCI trial”.

In announcing the change, the ACC said “in the last two years, new science has emerged showing potential improvements for some patients in their overall outcomes as a result of complete revascularization”. Earlier studies were inconclusive, the ACC said.

“Science is not static but rather constantly evolving,” said ACC President Patrick T. O’Gara, MD, FACC. “As such, one of the ACC’s primary roles is to stay abreast of this evolution and provide cardiovascular professionals and patients with the most up-to-date information on which to base decisions about the most appropriate and necessary treatment. The newest findings regarding coronary revascularization are great examples of science on the move, and we are responding accordingly.”

The ACC also noted that results from the CvLPRIT study reinforce data from another trial, the Preventive Angioplasty in Myocardial Infarction (PRAMI) Trial released in 2013, that show stenting all coronary arteries with major stenoses improves outcomes.

In its statement, the ACC concluded that since “some questions remain about the exact timing of the procedures; whether certain patients benefit versus others; whether 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”.