Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines.

Area of Science:

• Cardiology
• Evidence-based Medicine
• Health Research Methodology

Background:

• Systematic reviews (SRs) are crucial for developing evidence-based clinical practice guidelines (CPGs).
• The methodological quality and reporting clarity of SRs underpinning ST-elevation myocardial infarction (STEMI) CPGs require thorough assessment.
• International CPGs for STEMI management were examined for their reliance on SRs.

Purpose of the Study:

• To evaluate the methodological rigor of SRs used in STEMI CPGs.
• To assess the transparency and completeness of reporting in these supporting SRs.
• To identify deficiencies in SR methodology and reporting within STEMI CPGs.

Main Methods:

• Searched 13 guideline clearinghouses for English-language CPGs on STEMI management.
• Extracted 71 unique SRs from the reference lists of included CPGs.
• Assessed SR quality using the Appraisal of tools for systematic reviews (AMSTAR) and PRISMA checklist.

Main Results:

• Four CPGs were included, referencing 71 SRs with AMSTAR scores from 1 to 9.
• SRs consistently showed underperformance in disclosing funding, assessing risk of bias, and publication bias.
• PRISMA checklist completeness varied (44%-96%), with common omissions in search strategy, protocol registration, bias assessment, and funding sources.

Conclusions:

• Significant variability exists in the quality of SRs used for STEMI CPG recommendations.
• Guideline developers are aware of quality variations, but these deficiencies persist and require further attention.
• Improving SR quality and reporting is essential for robust CPG development in STEMI management.