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July 20, 2005

Acute Coronary Syndromes and Regionalization of Care—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;294(3):304-305. doi:10.1001/jama.294.3.304-b

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.

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