Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: The optimal treatment strategy for patients with STEMI without contraindications to thrombolysis when delay to primary PCI exceeds 90 minutes has been controversial.1 In their study of data from the RIKS-HIA, Dr Stenestrand and colleagues2 report a decrease in 30-day and 1-year mortality in patients treated with primary PCI compared with prehospital thrombolysis and in-hospital thrombolysis. The superiority of PCI was also sustained in patients with chest pain onset within 2 hours. The authors concluded that lytic therapy should only be considered for patients with pain onset within 2 hours and when transport delay to primary PCI exceeds 4 hours. In our opinion this conclusion is premature.
Legutko J, Siudak Z, Dudek D, Rzeszutko L. Percutaneous Coronary Intervention vs Thrombolysis for ST-Elevation Myocardial Infarction. JAMA. 2007;297(12):1313-1315. doi:10.1001/jama.297.12.1314-a