We agree that patients with non-STEMI who are at highest clinical risk would likely benefit from an early reperfusion strategy. However, patients with non-STEMI are heterogeneous and represent a wide spectrum of clinical risk and pathophysiologic features. These can range from a partially or completely occlusive thrombus to severe ischemia secondary to “supply-demand” mismatch. The benefits of an early reperfusion strategy would vary substantially for these different scenarios.
Ting HH, Nallamothu BK, Krumholz HM. Percutaneous Intervention for Non–ST-Segment Elevation Myocardial Infarction Within the Therapeutic Time Window for Acute Myocardial Infarction—Reply. Arch Intern Med. 2011;171(10):941-954. doi:10.1001/archinternmed.2011.192