AHA GUIDELINES Bundle (free trial)

ST-Elevation Myocardial Infarction

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Estimate of Certainty (precision) of Treatment Effect CLASS I Benefit >>>Risk Procedure/Treatment SHOULD be performed/administered CLASS IIa Benefit >>Risk Additional studies with focused objectives needed IT IS REASONABLE to perform procedure/ administer treatment LEVEL A Multiple populations evaluated* ▪Recommendation that ▪Recommendation in favor of procedure or treatment treatment or procedure being is useful/effective useful/effective Data derived from multiple randomized clinical trials or metaanalyses LEVEL B Limited populations evaluated* ▪Sufficient evidence from multiple randomized trials or meta-analyses ▪Recommendation that procedure or treatment is useful/effective ▪Some conflicting evidence from multiple randomized trials or meta-analyses Data derived from a single randomized trial or nonrandomized studies LEVEL C Very limited populations evaluated* Only consensus opinion of experts, case studies, or standards of care ▪Evidence from single randomized trial or nonrandomized studies ▪Recommendation that procedure or treatment is useful/effective ▪Some conflicting evidence from single randomized trial or nonrandomized studies ▪Recommendation in favor of treatment or procedure being useful/effective ▪Only expert opinion, case studies, or standard of care Suggested phrases should for writing is recommended recommendations: is indication is useful/effective/ beneficial Comparative effectiveness treatment/strategy phrases†: a is recommended/ indicated in preference to treatment B treatment a should be chosen over treatment B ▪Only diverging expert opinion, case studies, or standard of care is reasonable can be useful/effective/ beneficial is probably recommended or indicated treatment/strategy a is probably recommended/indicated in preference to treatment B it is reasonable to choose treatment a over treatment B ▪Recommendation in favor of treatment or procedure being useful/effective A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. 26

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