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Editor's Correspondence
May 23, 2011

Percutaneous Intervention for Non–ST-Segment Elevation Myocardial Infarction Within the Therapeutic Time Window for Acute Myocardial Infarction—Reply

Author Affiliations

Author Affiliations: Knowledge and Evaluation Research Unit, Division of Cardiovascular Diseases, and Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota (Dr Ting); VA Health Services Research and Development Center for Excellence, Department of Medicine, University of Michigan Medical School, Ann Arbor (Dr Nallamothu); and Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, and Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Dr Krumholz).

Arch Intern Med. 2011;171(10):941-954. doi:10.1001/archinternmed.2011.192

In reply

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.

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