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In Reply: In our article we emphasized that registry studies can never replace prospective randomized trials in establishing the efficacy of a treatment. However, randomized trials have shortcomings regarding the effectiveness of a treatment in the real world, when the treatment is applied in all types of patients and hospitals. The differences in baseline characteristics pointed out by Dr Rihal and colleagues (eg, sex, age, previous heart failure) were accounted for in the multivariable analysis and should not influence the outcome in the different reperfusion groups. In our article, we acknowledged that unmeasured factors could have influenced the result. Still, concordance of randomized trials^1-2 and registry studies, as in the case of primary PCI compared with thrombolysis, supports the validity of the measured efficacy of the therapy.

Many investigators believe that an early invasive strategy after fibrinolysis should improve outcome.³ However, randomized trials⁴ show no benefit of "facilitated PCI" early . . . [Full Text of this Article]

Ulf Stenestrand, MD, PhD
stenestrand@riks-hia.se
Department of Cardiology
University Hospital of Linköping
Linköping, Sweden

Johan Lindbäck, MSc; Lars Wallentin, MD, PhD
Uppsala Clinical Research Center
Uppsala University
Uppsala, Sweden

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