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In Reply: Dr Alfonso requests details regarding cardiac vs noncardiac mortality and myocardial infarction size. Unfortunately, our mortality committee did not distinguish cardiac from noncardiac death. We accumulated limited data on myocardial infarctions because these patients were not always readmitted to our institution. Although we agree that larger vs smaller creatine kinase-MB elevations predict a higher mortality rate, data from the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial suggests that even modest creatine kinase-MB elevations are associated with an increased risk for later mortality.¹

Considering the 12-month landmark analysis, Alfonso inquires whether the 0% rate of death or myocardial infarction observed at 24 months for DES patients using clopidogrel may be a chance finding. Fourteen events occurred in DES patients, all of these in patients not reporting clopidogrel use. This equated to a 4.5% absolute reduction in death or myocardial infarction (95% confidence interval . . . [Full Text of this Article]

Eric L. Eisenstein, DBA
eric.eisenstein@duke.edu

David F. Kong, MD; Kevin J. Anstrom, PhD
Duke Clinical Research Institute

Robert M. Califf, MD
Duke Translational Medicine Institute
Durham, NC

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RELATED ARTICLE

Association Between Minor Elevations of Creatine Kinase-MB Level and Mortality in Patients With Acute Coronary Syndromes Without ST-Segment Elevation
John H. Alexander, Rodney A. Sparapani, Kenneth W. Mahaffey, Jaap W. Deckers, L. Kristin Newby, E. Magnus Ohman, Ramòn Corbalàn, Sergio L. Chierchia, Jean B. Boland, Maarten L. Simoons, Robert M. Califf, Eric J. Topol, Robert A. Harrington, and for the PURSUIT Steering Committee
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