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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.294.16.2031-a

To the Editor: We would like to raise 2 issues in response to the article reporting results of the Beyond 12 hours Reperfusion AlternatiVe Evaluation (BRAVE-2) trial by Dr Schömig and colleagues.1 First, the use of abciximab before PCI in patients with acute MI within 12 hours of symptom onset has been shown to reduce the 30-day incidence of death and MI, and this benefit is independent of the type of device used during the procedure.2 Given this, abciximab alone could have accounted for the reduction in infarct size found in these patients rather than combined effect of abciximab and primary PCI. In addition, the absence of benefit for the secondary clinical end points suggests that an effect modification may have occurred between the 2 modes of therapy among the patients in the intensive treatment group.