2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS , engl.

Year of publication: 2018

Editing medical society(ies):
European Society of Cardiology (ESC)

Other medical societies involved: 0

Evaluation by Leitlinienwatch






European guideline outside the German AWMF system. ESC guidelines are adopted by the Deutsche Gesellschaft für Kardiologie (German Society of Cardiology). (https://academic.oup.com/eurheartj/article/39/3/213/4095043).
Conflicts of interest are documented and include the names of the companies. However, COI are not evaluated by an independent panel. (https://www.escardio.org/static_file/Escardio/Guidelines/DOI/DOI_Summary_2017_DAPT.pdf)

Individual authors who do not declare any institutional or personal conflicts of interest do disclose conflicts of interest in other publications related to the contents of the guidelines. (N Engl J Med 2014;371:1208-17.DOI: 10.1056/NEJMoa1408758 / N Engl J Med 2019;381:1524-34. DOI: 10.1056/NEJMoa1908973 / J. of Cardiovasc. Trans. Res. (2014) 7:91–100 DOI 10.1007/s12265-013-9527-3). It is possible that different periods of time were covered here. The ESC only requests information from the past year while the international standard is to disclose at least the last three years.


Composition of the Guideline Working Group

Thirteen out of 18 authors declared conflicts of interest; 11 of those 13 had direct conflicts of interest (with personal fees received), while the rest received research support from the industry.


Independence of the Coordinators/Chairs/Lead AuthorsUnabhängigkeit der Vorsitzenden/federführenden Autoren

The corresponding author declares personal conflicts of interest.


Abstention from Voting

Information regarding voting behavior is not provided. The ESC has not yet implemented a rule regarding abstention in cases involving conflicts of interest.


External Review of the Guideline


Bonus Points

An internal review was performed. Eighty-six percent of these reviewers also declare conflicts of interest. A public review would have the advantage of giving a voice to independent clinicians and scientists who are not being paid by the manufacturers of the products under evaluation.

Explanations to the evaluation criteria

Overall score


Good! (11-18)

Warning! (6-10)

Needs reform! (0-5)


This clinically relevant guideline exhibits the same problems as the other ESC guidelines evaluated by Leitlinienwatch: The vast majority of the authors, including the lead author, declare conflicts of interest. Additionally, an assessment based on random samples indicates that two authors have undeclard conflicts of interest that are relevant to the guideline which may have occurred outside of the time period sampled by the ESC. This raises the question which period of time should be sampled for disclosure of relevant conflicts of interest. One year is regarded as insufficient by international standards. Furthermore, there is no documentation regarding whether abstention from voting was even considered when there were conflicts of interest. With regard to the international trend toward limiting commercial influence on guidelines it is high time for reform at the ESC.

Note: This evaluation was conducted with due care on the basis of the published guideline. Should you still discover an error, please contact us at info@leitlinienwatch.de.