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March 28, 2007

Percutaneous Coronary Intervention vs Thrombolysis for ST-Elevation Myocardial Infarction—Reply

Author Affiliations

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

JAMA. 2007;297(12):1313-1315. doi:10.1001/jama.297.12.1314-b

In Reply: In our article we emphasized that registry studies can never replace prospective randomized trials in establishing the efficacy of a treatment. However, randomized trials have shortcomings regarding the effectiveness of a treatment in the real world, when the treatment is applied in all types of patients and hospitals. The differences in baseline characteristics pointed out by Dr Rihal and colleagues (eg, sex, age, previous heart failure) were accounted for in the multivariable analysis and should not influence the outcome in the different reperfusion groups. In our article, we acknowledged that unmeasured factors could have influenced the result. Still, concordance of randomized trials1,2 and registry studies, as in the case of primary PCI compared with thrombolysis, supports the validity of the measured efficacy of the therapy.

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