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In Reply: As noted in the Commentary, evidence comparing the efficacy of primary PCI and fibrinolytic agents for eligible patients with ST-segment elevation ACS continues to evolve, particularly in light of promising findings concerning prehospital fibrinolysis.¹ Commonly cited data supporting primary PCI at hospitals without onsite surgical back-up come from the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT) trial, a study that was aborted before completion of patient enrollment because funding could not be maintained.² While some may find C-PORT’s evaluation of 451 patients treated at 11 hospitals in 2 states sufficient grounds to advocate a new national standard for primary PCI, we believe prudence dictates otherwise.

Compared with the issue of primary PCI vs fibrinolytic therapy as a sole treatment standard, we believe the more pressing question concerns treatment-associated delay and its impact on treatment outcomes. Any proposed ACS regionalization policy must identify the point at which the additional . . . [Full Text of this Article]

Saif S. Rathore, MPH
saif.rathore@yale.edu
MD/PhD Program

Andrew J. Epstein, MPP, PhD
Department of Epidemiology and Public Health
Yale University School of Medicine
New Haven, Conn

Kevin G. M. Volpp, MD, PhD
Department of Medicine
University of Pennsylvania School of Medicine
Philadelphia

Harlan M. Krumholz, MD, SM
Robert Wood Johnson Clinical Scholars Program
Department of Internal Medicine
Yale University School of Medicine
New Haven, Conn

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