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To the Editor: Dr Stenestrand and colleagues¹ reported that in the Registry of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA), PCI compared with thrombolytic therapy was independently associated with lower short-term and long-term mortality rates in patients with STEMI. We agree that registry data from unselected patient populations provide valuable insights into management patterns and treatment effectiveness in the "real world." However, several issues deserve further comment.

As the authors noted, the choice of reperfusion strategy was predominantly influenced by the local availability of treatment facilities rather than individual patient characteristics. For example, prehospital thrombolysis was available in about half of the participating hospitals and not all centers performed PCI. Although the multivariable analysis and propensity score included the hospital type and on-site availability of cardiac catheterization facilities, hierarchical modeling may yield more reliable results given the clustering of patients within hospitals and geographic regions.^2-3

The conclusion . . . [Full Text of this Article]

Andrew T. Yan, MD; Raymond T. Yan, MD; Shaun G. Goodman, MD, MSc
goodmans@smh.toronto.on.ca
St. Michael's Hospital
University of Toronto
Toronto, Ontario

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