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October 26, 2005

Mechanical Reperfusion More Than 12 Hours After Acute Myocardial Infarction

JAMA. 2005;294(16):2030-2032. doi:10.1001/jama.294.16.2030-b

To the Editor: The study by Dr Schömig and colleagues1 of percutaneous coronary intervention (PCI) in patients presenting more than 12 hours after acute ST-segment elevation myocardial infarction (STEMI) is methodologically flawed because it does not report data that would distinguish delayed presentation after the onset of cardiac ischemia without infarction vs the actual onset of myocardial infarction (MI). The study used minimal entry criteria of a single episode of chest pain lasting at least 20 minutes, occurring more than 12 hours before presentation, along with electrocardiographic changes at presentation. On this basis, some of the study patients could have had an infarction less than 12 hours old.