SCAI Issues Recommendation of Tests and Treatments to Avoid

March 31, 2014—The Society for Cardiovascular Angiography and Interventions (SCAI) issued a list of five specific, evidence-based recommendations that should be avoided in the care of patients who have, or are at risk for, cardiovascular disease.

SCAI’s list was developed as part of the “Choosing Wisely” campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation, to help physicians and patients make wise decisions together about the most appropriate care based on individual situations. The rationale for each of SCAI’s recommendations can be reviewed on the society’s website, www.SCAI.org.

SCAI’s five recommendations are: 

1.  Avoid routine stress testing after percutaneous coronary intervention (PCI) without specific clinical indications. 

2.  Avoid coronary angiography in postcoronary artery bypass graft and post-PCI patients who are asymptomatic, or who have normal or mildly abnormal stress tests and stable symptoms not limiting quality of life. 

3.  Avoid coronary angiography for risk assessment in patients with stable ischemic heart disease who are unwilling to undergo revascularization or who are not candidates for revascularization based on comorbidities or individual preferences. 

4.  Avoid coronary angiography to assess risk in asymptomatic patients with no evidence of ischemia or other abnormalities on adequate noninvasive testing. 

5.  Avoid PCI in asymptomatic patients with stable ischemic heart disease without the demonstration of ischemia on adequate stress testing or with abnormal fractional flow reserve testing. 

According to SCAI, this list is based on guidelines and appropriate-use criteria developed by SCAI, the American College of Cardiology, American Heart Association, and other professional societies. All of the tests and procedures on SCAI’s list have been deemed to be “inappropriate” or “rarely appropriate,” according to the latest appropriate-use criteria, or are “not recommended,” according to the most current professional guidelines. SCAI selected these items because appropriate use criteria and guidelines have been carefully vetted, adjudicated, and agreed upon by experts from many societies.

In the society’s press release, SCAI Vice President James C. Blankenship, MD, commented, “We believe this list will spur conversations between heart patients and their physicians to make wise decisions about care based on their individual situation. Our goal is to improve care for the patient and eliminate unnecessary tests and procedures.”

SCAI President Ted A. Bass, MD, added, “Discussion between the physician and the patient and patient’s family is the foundation for delivering optimal, effective care. Clinical judgment remains critical in determining the best course of care for the individual patient, with the complementary use of guidelines and appropriate use criteria.”

More information about the campaign, including the complete lists and additional details about the recommendations and evidence supporting them, is available on the "Choosing Wisely" website, www.choosingwisely.org. The ABIM Foundation is a not-for-profit foundation established by the ABIM in 1999 to advance medical professionalism and physician leadership in quality assessment and improvement. More information is available online at www.abimfoundation.org.