Trial reportEuropean heart journal. Quality of care & clinical outcomes2023
Representativeness in randomised clinical trials supporting acute coronary syndrome guidelines.
Trial report in European heart journal. Quality of care & clinical outcomes, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed.
- Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI.ESC heart failure · 2025Trial
- Effect of low-dose colchicine on pericoronary inflammation and coronary plaque composition in chronic coronary disease: a subanalysis of the LoDoCo2 trial.Heart (British Cardiac Society) · 2025Trial
- Temporal trends and prognostic impact of pre-hospital delay in ST-elevation myocardial infarction-20-year observational study from the SWEDEHEART registry.European heart journal. Acute cardiovascular care · 2026Observational
- The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma.Lancet (London, England) · 2025Review
- Stepwise dual antiplatelet therapy de-escalation in patients after drug coated balloon angioplasty (REC-CAGEFREE II): multicentre, randomised, open label, assessor blind, non-inferiority trial.BMJ (Clinical research ed.) · 2025Article
- Variation in Likelihood of Undergoing Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among US Hospitals.Journal of the American Heart Association · 2025Article
- Older women with non-ST-elevation acute coronary syndrome undergoing invasive or conservative management: an individual patient data meta-analysis.European heart journal open · 2024Article
- Long-Term Clinical Outcomes Following the WATCHMAN Device Use in Medicare Beneficiaries.Circulation. Cardiovascular quality and outcomes · 2024Article
- Myocardial Infarction Quality of Care and Outcomes in Asian Ethnic Groups in the United States.Circulation. Cardiovascular quality and outcomes · 2024Article
- Type of evidence supporting ACC/AHA and ESC clinical practice guidelines for acute coronary syndrome.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Article
- Type of evidence supporting ACC/AHA and ESC clinical practice guidelines for acute coronary syndrome.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Article
- Sex differences in outcomes after acute coronary syndrome vary with age: a New Zealand national study.European heart journal. Acute cardiovascular care · 2024Article
- Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida.Circulation. Cardiovascular imaging · 2023Article
- Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning.European heart journal. Acute cardiovascular care · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
aimsClinical practice guidelines (CPGs) are published to guide the management of acute coronary syndrome (ACS). We aimed to critically appraise the representativeness and standard of care of randomised clinical trials (RCTs) supporting CPGs for ACS. METHODS AND
resultsAmerican and European CPGs for ST- and non-ST-elevation ACS were screened to extract all references (n = 2128) and recommendations (n = 600). Among the 407 primary publications of RCTs (19.1%), there were 52.6 and 73.2% recruiting patients in North America and Europe, respectively, whereas other regions were largely under-represented (e.g. 25.3% RCTs recruited in Asia). There was 68.6% RCTs enrolling patient with ACS, whereas the remaining 31.4% did not enrol any patient with ACS. There was under-representation of some important subgroups, including elderly, female (29.9%), and non-white patients (<20%). The incidence and type of reperfusion reported in these RCTs were not reflective of current clinical practice (the percentage of patients who underwent percutaneous coronary intervention (PCI) among all RCTs was 42.7%; whereas for ST-Elevation Myocardial Infarction patients, the number of participants who underwent fibrinolysis was 3.3-fold higher than those who underwent primary PCI). All-cause mortality in these RCTs was 11.9% in RCTs with a follow-up ≤ 1 year.
conclusionRandomised clinical trials supporting CPGs for ACS are not fully representative of the diversity of the ACS population and their current standard of care. While some of these issues with representativeness may be explained by how evidence has been accrued over time, efforts should be made by trialists to ensure that the evidence supporting CPGs is representative of the wider ACS population.
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What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.