In reply
Acute coronary ischemic syndromes span the spectrum from unstable angina to myocardial infarction. Within this spectrum, current classifications distinguish ST-elevation myocardial infarction, which is treated using a reperfusion strategy, from non–ST-elevation myocardial infarction, which is treated medically. This distinction replaces the terms Q-wave myocardial infarction andnon–Q-wave myocardial infarction, respectively, a classification used in many of the older trials referred to in our review article. Although we agree with Dr Phibbs that the term non–Q-wave myocardial infarction is outdated, there is no evidence that patients with non–ST-elevation myocardial infarction or non–Q-wave myocardial infarction benefit from reperfusion therapy. Therefore, regardless of the terminology, these patients are prime candidates for the new therapies outlined in our article.