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In Reply: The meta-analysis by Drs Bavry and Kumbhani¹ using selective inclusion of trials of invasive vs conservative therapy performed after 1999 is consistent with the overall results of our meta-analysis, which includes the totality of data from all of the randomized trials addressing this question. Figure 5 of our article reports a subgroup analysis of trials performed after 1999 and shows consistent benefit of the invasive strategy in these latter trials. However, the analysis by Bavry and Kumbhani did not show a mortality benefit at 12 months and included a trial that allocated patients to management strategy according to day of the week, potentially producing a biased result in favor of invasive therapy.² Second, randomized trials evaluating the use of stents have not found stent use to reduce mortality or MI.³ Third, the overwhelming majority of patients in the recent trials did not actually use Gp IIb/IIIIa inhibitors: only . . . [Full Text of this Article]

Shamir R. Mehta, MD, MSc
smehta@mcmaster.ca
Department of Interventional Cardiology

Salim Yusuf, DPhil
Department of Medicine
McMaster University
Hamilton, Ontario

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