Table 3: Classes of recommendation and levels of evidence.

Class

Definition

I

Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, and effective

IIa

Weight of evidence/opinion is in favor of usefulness/efficacy

IIb

Usefulness/efficacy is less well established by evidence/opinion

III

Evidence or general agreement that the treatment or procedure is not useful/effective and in some cases may be harmful

Level

Source of evidence

A

Data derived from multiple randomized clinical trials or meta-analyses

B

Data derived from a single randomized clinical trial or large non-randomized studies

C

Consensus of expert opinion and/or small studies, retrospective studies, registries

Classification of recommendations and levels of evidence adapted from the European Society of Cardiology (ESC) Guidelines.6,7,16