Article type
Abstract
Background: The uncertainties regarding multiple guidelines has dramatically altered ST-elevation myocardial infarction assessment and management, physicians require systematically and transparently developed recommendations.
Objectives:This systematic review assesses the quality and consistency of these multiple guidelines of international clinical practice guidelines (CPGs) for the diagnosis and management of ST-elevation myocardial infarction to assist physicians in making appropriate recommendations.
Methods:We chose three CPGs on the management of ST-elevation myocardial infarction (STEMI) published before December 2016 were retrieved. Four reviewers independently assessed the rigour of guideline development by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and their reported evidence was evaluated.
Results: Three eligible guidelines were included: two had been developed by professional organisations (NICE, 2013 and SIGN, 2016), and one guideline was endorsed by an independent regional body (Taiwan, 2012). Three guidelines achieved a score of greater than 50% in all six AGREE-II domains. Most CPG recommendations on the management of STEMI were relatively consistent. Guidelines varied regarding the indication of morphine for chest pain, as well as in their suggestions for aspirin dose.
Conclusions:Our analysis showed that the current CPGs varied in methodological quality. More effort is needed to improve the quality of recommendations on the diagnosis and management of ST-elevation myocardial infarction.
Objectives:This systematic review assesses the quality and consistency of these multiple guidelines of international clinical practice guidelines (CPGs) for the diagnosis and management of ST-elevation myocardial infarction to assist physicians in making appropriate recommendations.
Methods:We chose three CPGs on the management of ST-elevation myocardial infarction (STEMI) published before December 2016 were retrieved. Four reviewers independently assessed the rigour of guideline development by using the Appraisal of Guidelines Research and Evaluation II (AGREE-II) instrument, and their reported evidence was evaluated.
Results: Three eligible guidelines were included: two had been developed by professional organisations (NICE, 2013 and SIGN, 2016), and one guideline was endorsed by an independent regional body (Taiwan, 2012). Three guidelines achieved a score of greater than 50% in all six AGREE-II domains. Most CPG recommendations on the management of STEMI were relatively consistent. Guidelines varied regarding the indication of morphine for chest pain, as well as in their suggestions for aspirin dose.
Conclusions:Our analysis showed that the current CPGs varied in methodological quality. More effort is needed to improve the quality of recommendations on the diagnosis and management of ST-elevation myocardial infarction.