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ST-Elevation Myocardial Infarction

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Size of Treatment Effect CLASS IIb CLASS III No Benefit Benefit ≥Risk or CLASS III Harm Additional studies with broad Procedure/ objectives needed; additional registry Test data would be helpful Not Helpful COR III: Procedure/Treatment No benefit MAY BE CONSIDERED Excess Cost COR III: w/o Benefit Harm or Harmful Treatment No Proven Benefit Harmful to Patients ▪Recommendation's usefulness/ efficacy less well established ▪Recommendation that procedure or treatment is not useful/effective and may be harmful ▪Greater conflicting evidence from multiple randomized trails or metaanalyses ▪Sufficient evidence from multiple randomized trials of meta-analyses ▪Recommendation's usefulness/ efficacy less well established ▪Recommendation that procedure or treatment is not useful/effective and may be harmful ▪Greater conflicting evidence from single randomized trial or nonrandomized studies ▪Evidence from single randomized trial or nonrandomized studies ▪Recommendation's usefulness/ efficacy less well established ▪Recommendation that procedure or treatment is not useful/effective and may be harmful ▪Only diverging expert opinion, case studies, or standard of care ▪Only expert opinion, case studies, or standard of care may/might be considered may/might be reasonable usefulness/effectiveness is unknown/ unclear/uncertain or not well established COR III: No benefit is not recommended is not indicated should not be performed/ administered/other is not useful/ beneficial/effective COR III: Harm potentially harmful causes harm associated with excess morbidity/mortality should not be performed/ administered/other * Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. † For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. 27

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