Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: As noted in the Commentary, evidence
comparing the efficacy of primary PCI and fibrinolytic agents for eligible
patients with ST-segment elevation ACS continues to evolve, particularly in
light of promising findings concerning prehospital fibrinolysis.1 Commonly
cited data supporting primary PCI at hospitals without onsite surgical back-up
come from the Atlantic Cardiovascular Patient Outcomes Research Team (C-PORT)
trial, a study that was aborted before completion of patient enrollment because
funding could not be maintained.2 While some
may find C-PORT’s evaluation of 451 patients treated at 11 hospitals
in 2 states sufficient grounds to advocate a new national standard for primary
PCI, we believe prudence dictates otherwise.
Rathore SS, Epstein AJ, Volpp KGM, Krumholz HM. Acute Coronary Syndromes and Regionalization of Care—Reply. JAMA. 2005;294(3):304-305. doi:10.1001/jama.294.3.304-b