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In Reply: Dr Perlmutter points out that our study took place during extended weekday hours. This was based on budget issues for the study. Currently, there are US hospitals that provide around-the-clock myocardial perfusion imaging,¹ including some in our trial. The decision to provide such full-time access must be based on the potential need for the test in the ED, and on the staffing and availability of nuclear technologists, among other factors.

Ours was a clinical effectiveness trial testing an intervention as it would be used in usual practice. Accordingly, cardiologists were not excluded from early decision making; indeed, an attending cardiologist was directly involved in 20% of the decisions, and in an additional 10%, a cardiologist was involved by telephone or in person. Early (immediate) exercise testing also was not precluded; the "usual care" strategy group could undergo any type of testing available at a center. Published reports of . . . [Full Text of this Article]

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