Reversal of Therapeutic Recommendations in the American College of Cardiology Coronary Artery Disease Guidelines

Le résumé fourni par la source

Background: Medical reversal is defined as the discontinuation of a procedure's recommendation due to new evidence regarding its efficacy or safety.Cardiology is the specialty with the highest number of documented reversals, yet there is no information available about the probability of reversal.Objectives: To describe the frequency of medical reversal in the ischemic heart disease guidelines published by the American College of Cardiology/American Heart Association (ACC/AHA), according to levels of evidence.Methods: The most recent guidelines for stable coronary disease, non-ST-elevation acute coronary syndrome, and STelevation myocardial infarction were compared with the first version.Medical reversal was defined as a shift from a recommended procedure to a contraindicated one or the removal of the recommendation.The quality of evidence was categorized by the guidelines as high, moderate, or low.Results: A total of 224 therapeutic recommendations were identified, with 19% based on high-quality evidence, 42% on moderate-quality evidence, and 39% on low-quality evidence.Forty-nine medical reversals were observed, constituting 22% of all therapeutic recommendations included in the first version of the guidelines.The probability of reversal for procedures based on high-quality evidence was 2%, compared with 25% for procedures with moderate-quality evidence and 30% for procedures with low-quality evidence.Conclusion: In the ACC/AHA ischemic heart disease guidelines, medical reversal is common in recommendations based on moderate or low-quality evidence, but rare in those with high-quality evidence.

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