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Mechanical Reperfusion More Than 12 Hours After Acute Myocardial Infarction—Reply
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In Reply: Drs Rubin and Warner are concerned that no cardiac biomarkers were used to assess time delay to presentation for the patients with acute STEMI included in the BRAVE-2 trial. The goal of the BRAVE 2 trial was to assess whether an invasive strategy is associated with reduction of infarct size in patients with STEMI presenting more than 12 hours after symptom onset. The study was based on symptoms and unequivocal electrocardiographic changes to define acute MI, and on the interval from symptom onset to define time to presentation.
Pivotal studies assessing optimal treatment strategies for patients with acute MI have used interval from symptom onset rather than enzymatic criteria to define early1 or late2-3 presentation. In 1 of these trials,3 biomarker evidence subsequent to randomization was sought only in case of equivocal electrocardiographic changes. Also, guidelines on treatment of acute MI4 used interval from symptom onset, not enzymatic . . . [Full Text of this Article]
Albert Schömig, MD
aschoemig@dhm.mhn.de
Gjin Ndrepepa, MD;
Adnan Kastrati, MD
Deutsches Herzzentrum
Technische Universität
Munich, Germany
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