Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Alfonso requests details regarding cardiac vs noncardiac mortality and myocardial infarction size. Unfortunately, our mortality committee did not distinguish cardiac from noncardiac death. We accumulated limited data on myocardial infarctions because these patients were not always readmitted to our institution. Although we agree that larger vs smaller creatine kinase-MB elevations predict a higher mortality rate, data from the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial suggests that even modest creatine kinase-MB elevations are associated with an increased risk for later mortality.1
Eisenstein EL, Kong DF, Anstrom KJ, Califf RM. Clopidogrel and Long-term Outcomes After Drug-Eluting Stent Implantation—Reply. JAMA. 2007;297(16):1769-1771. doi:10.1001/jama.297.16.1770-c