Coevolutionary analysis of evidence and recommendations in STEMI clinical practice guidelines: A 33-year meta-research study of American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC)
Authors' conclusion
STEMI-related recommendations from foremost cardiology societies worldwide have largely relied on moderate/low-quality evidence, with slight changes over time.
Study context
- Population
- STEMI clinical practice guidelines (CPGs) (acute in-hospital management) endorsed by AHA, ACC and ESC, 1990–202326 guidelines
- Participants
- 2,139 participants
- Comparison
- PI vs NPI recommendations
- Outcome
- Classification of recommendations (CORs) and LOE of STEMI guideline recommendations over time
- Follow-up
- 1990 to 2023
Methodological detailsData extracted by 2 content experts; changes evaluated with chi-square test
- Data extracted by 2 content experts; changes evaluated with chi-square test
Main finding
As reported in the abstract
LOE of recommendations over the 33-year span
LOE-B (moderate quality) recommendations
30.1%
LOE-C (low quality) recommendations
28.9%
Recommendations based on high-quality evidence
17.7%
Further findings
LOE-A recommendations, PI vs NPI
P < 0.05
Changes in level of evidence (LOE) and COR between two consecutive guidelines
- Changes in LOE and COR for corresponding recommendations were minimal
Original publication
Coevolutionary analysis of evidence and recommendations in STEMI clinical practice guidelines: A 33-year meta-research study of ACC, AHA, and ESC. Am Heart J. Published 18 December 2025. doi:10.
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