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July 20, 2005

Acute Coronary Syndromes and Regionalization of Care

Author Affiliations

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

JAMA. 2005;294(3):304-305. doi:10.1001/jama.294.3.304-a

To the Editor: The Commentary on regionalization of care for acute coronary syndromes (ACS) by Mr Rathore and colleagues1 did not directly address the most important advantage of transporting patients to hospitals with percutaneous coronary intervention (PCI) capability. The focus should not be the broad condition of ACS, but rather the individual patient with ST-elevation myocardial infarction (STEMI). Primary studies and quantitative reviews show that, for STEMI patients, PCI improves outcomes compared with intravenous fibrinolytic therapy.2 This is especially true for the combined end point of death, recurrent ischemia, or stroke, even in hospitals with new PCI programs using higher volume operators.3