To the Editor While Jena et al1 should be congratulated on rigorous analytic technique, we fear they have misinterpreted their results with regards to the effects of early intervention in high-risk acute myocardial infarction (AMI).
Patients with AMI undergoing percutaneous coronary intervention may be more likely to have early adverse effects of invasive procedures.2 However, data from randomized clinical trials have consistently demonstrated several longer-term benefits with early invasive strategies and more aggressive use of percutaneous coronary intervention in patients presenting with AMI.2- 4 These may include mortality improvements, as well as improvements in other important patientcentric outcomes such as reduced recurrent myocardial infarction, reduced need for urgent revascularization, and freedom from angina. These benefits manifest over intermediate to long-term follow-up which is unavailable in the current analysis. Importantly, patients with the highest-risk features demonstrate the greatest magnitude of overall long-term benefit from aggressive early invasive therapies.2,4
Kobayashi T, Giri J. Changes in Hospitalizations, Treatment Patterns, and Outcomes During Major Cardiovascular Meetings. JAMA Intern Med. 2015;175(8):1420. doi:10.1001/jamainternmed.2015.1639