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To the Editor: Dr Neumann and colleagues¹ found that in patients with unstable coronary syndromes, those who had deferred catheter intervention for prolonged antithrombotic pretreatment ("cooling off") had somewhat worse outcomes than those who had immediate intervention accompanied by intense antiplatelet treatment.

I would appreciate it if the authors would provide additional details regarding the definitions and timing of nonfatal reinfarction. In particular, it is unclear how they decided whether to classify an infarction as an index event or as an end point. This seems especially problematic, as 67% of all patients had elevated levels of cardiac troponin T at presentation. It would be of interest to know how many patients in each group had elevated levels of creatine kinase and its MB isoenzyme at presentation. This is particularly important, as an end-point infarction was defined as "new Q waves in 2 or more contiguous electrocardiographic leads" in 11 of . . . [Full Text of this Article]

Shaun Goodman, MD, MSc
Canadian Heart Research Centre
Toronto, Ontario

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