The ACC has released an updated list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely campaign, led by the ABIM Foundation. The update includes a new recommendation not to “perform routine electrocardiography (ECG) screening as part of pre–operative or pre–procedural evaluations for asymptomatic patients with low perioperative risk of death or myocardial infarction.”

The recommendation states: “Despite potential value in having a pre–operative ECG to identify unsuspected cardiac abnormalities or as a comparison after a perioperative event, the likelihood of benefit for patients at low risk of major cardiovascular events is very small.” The recommendation notes the absence of scientific studies establishing the value of a pre–operative ECG in low–risk patients and cautions that unnecessary ECGs can lead to needless consults, delays and changes to operative plans, which may counterbalance any potential patient benefits.

The new recommendation now brings the total number of ACC recommendations back to five. Following new data showing potential improvements for some patients as a result of complete revascularization, the College in 2014 withdrew the recommendation that heart attack patients should have only their culprit artery unblocked and should question whether complete revascularization of all nonculprit lesions should be performed.