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To the Editor: As authors of the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI) trial,¹ and on behalf of the APEX AMI study group, we believe that the accompanying Editorial by Drs Eikelboom and O’Donnell² raises 3 issues deserving clarification. First, the Editorial questions the rationale for targeting one half of the original number of anticipated events. Prior to unblinding the results, we reported³ that the rationale was based in part on the prior systematic overview.⁴ When combined with the results from Pexelizumab for Reduction of Infarction and Mortality in Coronary Artery Bypass Grafting surgery (PRIMO-CABG II) in a meta-analysis, there was an overall relative risk reduction of 24% (95% confidence interval, 0.61-0.93; log rank P = .009) in all-cause 30-day mortality.⁵ If that effect had been observed in APEX, it would have achieved statistical significance (P<.05).

Second, the authors suggest that the meta-analysis⁵ failed to include . . . [Full Text of this Article]

Paul W. Armstrong, MD
paul.armstrong@ualberta.ca
University of Alberta
Edmonton, Alberta

Christopher B. Granger, MD
Duke University Medical Center
Durham, NC

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