Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Dr Goodman, we convened
an independent blinded end point committee to ensure unbiased assessment of
events, as we stated in our article. Goodman is concerned about the differentiation
between index infarctions that justified inclusion in the study and infarctions
that subsequently occur as a complication. Indeed, this a problem in any study
that includes patients with non–ST-elevation myocardial infarction and
that concerns infarctions occurring within the first 8 hours after study entry.
In our study, myocardial infarction within 8 hours from randomization occurred
in 5 patients in the early intervention group and 6 patients in the prolonged
pretreatment group. If anything, these infarctions may have blunted the principal
finding of our study. If we exclude them from the analysis, the disadvantage
of the prolonged pretreatment becomes even more pronounced (relative risk,
2.5 [95% confidence interval, 1.1-6.0]).
Neumann F, Kastrati A, Schömig A. "Cooling-Off" vs Immediate Revascularization for Patients With Acute Coronary Syndromes—Reply. JAMA. 2004;291(6):691-692. doi:10.1001/jama.291.6.691-b