We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Better Outcome of Myocardial Infarction in Hospitals With PCI Facilities—Is It Because of More PCIs?

Andrew T. Yan, MD; Raymond T. Yan, MD; Shaun G. Goodman, MD, MSc
Arch Intern Med. 2008;168(2):240. doi:10.1001/archinternmed.2007.51.
Text Size: A A A
Published online


We read with interest the study by Labarere et al1 that compared the treatment and outcome of patients with ST-segment elevation myocardial infarction (STEMI) admitted to hospitals with vs without PCI facilities. We would like to offer an alternative explanation for the observed difference in outcome.

Although Labarere and colleagues1 suggested that the more frequent use of PCI within 48 hours of hospitalization accounted for the improved 1-year survival among patients admitted to PCI hospitals (Table 6 of their article), it should be emphasized that the overall rate of reperfusion therapy (primary PCI or thrombolytic) was also substantially higher (58% vs 40%) compared with non-PCI hospitals. Of note, neither facilitated PCI nor early routine invasive management conferred a mortality benefit in the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy With Percutaneous Coronary Intervention) and GRACIA (Grupo de Análisis de la Cardiopatía Isquémica Aguda)-1 trials.2,3 Furthermore, in the study by Labarere et al,1 patients in non-PCI hospitals were more likely to present late and with worse Killip class—clinical characteristics that favor the use of PCI as the preferred reperfusion therapy.4 Thus, it is plausible that the better outcome in PCI hospitals was due to the overall greater use and type of reperfusion therapy, rather than any PCI use within 48 hours of admission. It would also be useful to provide more data on the type of PCI (eg, facilitated, rescue, and ischemia guided) performed in the PCI hospitals.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Evidence To Support The Update

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Quick Reference