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To the Editor: Dr Allison and colleagues¹ found that teaching hospitals have better processes of care and outcomes for patients with acute myocardial infarction (AMI). This is quite different from the results of our study² of the same Cooperative Cardiovascular Project (CCP) data set. We found no independent association between teaching status and survival.

The 2 studies differ in several respects. Allison et al seem to exclude all 39 025 patients subsequently transferred to other hospitals, whom we assigned to the initial admitting hospital. The CCP hospitals without the ability to perform bypass surgery transferred 29.9% of patients, usually for angiography and revascularization. These patients had a 30-day mortality of 8.6%, which is half the rate of patients who were not transferred, and had higher compliance with process-of-care guidelines. Hospitals with high levels of technology transferred only 1.9% of their patients. Because availability of technology is strongly correlated with teaching status . . . [Full Text of this Article]

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