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To the Editor: Dr Magid and colleagues¹ concluded that patients treated at hospitals that performed more than 16 primary angioplasty procedures per year (93.5% of the procedures in the study) had lower in-hospital mortality rates with primary angioplasty than with thrombolytic therapy. Several other National Registry of Myocardial Infarction publications have also focused on primary angioplasty.^2-5 The inverse relationship between procedure volume and in-hospital mortality in this registry has been previously noted,^4-5 but the finding regarding superiority of primary angioplasty over thrombolytic therapy stands in contrast to previous publications where equivalence was demonstrated.^2-3

Magid et al suggest that the inclusion of low-volume primary angioplasty centers in previous reports explains this inconsistency, but Rogers et al³ found equivalent in-hospital mortality rates for myocardial infarction among hospitals with noninvasive catheterization or percutaneous transluminal coronary angioplasty (PTCA) capabilities, and higher mortality rates at hospitals that offer coronary artery bypass graft surgery. The authors . . . [Full Text of this Article]

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