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Table 3 GRADE assessment of confidence in estimates of effect in randomized trials

From: Cardiovascular and microvascular outcomes of glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized controlled cardiovascular outcome trials with trial sequential analysis

Outcome No. of participants (trials) Risk of bias Consistency Directness Precision Publication bias Quality
MACE 33,457 (4) No serious limitations Serious limitationsa No serious limitations No serious limitations No serious limitations Moderate
All-cause death 33,457 (4) No serious limitations No serious limitations No serious limitations No serious limitations No serious limitationsd High
Cardiovascular death 33,457 (4) No serious limitations No serious limitations No serious limitations No serious limitations No serious limitations High
Myocardial infarction 33,457 (4) No serious limitations No serious limitationsb No serious limitations Serious limitationsc No serious limitations Moderate
Stroke 33,457 (4) No serious limitations No serious limitationsb No serious limitations No serious limitations No serious limitations High
Hospitalization for heart failure 33,457 (4) No serious limitations No serious limitations No serious limitations Serious limitationsc No serious limitations Moderate
  1. GRADE Grading of Recommendations Assessment, Development and Evaluation
  2. aModerate to substantial heterogeneity: I2 = 50.1%
  3. bI2 = 24.4 and 28.8% respectively. Did not downgrade for mild heterogeneity
  4. c95% confidence interval (CI) include important harm and benefit
  5. dDid not downgrade even though Egger’s test detected a possible publication bias. We did not downgrade because all trials included were large-scale randomized trials and these tests had limited ability to adequately assess small-study effects due to a small number of trials