Editor's Correspondence |

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

Oscar M. P. Jolobe, MRCP
Arch Intern Med. 2011;171(10):941-954. doi:10.1001/archinternmed.2011.191.
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Given that as many as 47% of patients with non–ST-segment elevation myocardial infarction (non-STEMI) belong to the grade “0” Thrombolysis in Myocardial Infarction (TIMI) flow category (when angiography is performed, which, in most patients, is within 6 hours of arrival in hospital),1 it may be premature to state that

Even allowing for some ambiguity in the wording of that statement, the role of percutaneous intervention (PCI) in patients with non-STEMI who have angiographic documentation of thrombotic occlusion within the 3-hour therapeutic time window, which is the one advocated for PCI treatment of acute myocardial infarction,3 can only be established by a randomized controlled trial. For such a trial to enroll sufficient numbers of patients, obstacles to early presentation2 will have to be eliminated, including the delay between arrival in hospital and team notification.1 Furthermore, when interpreting the results of such a trial, allowance will also have to be made for the fact that 60% to 65.5% of patients with non-STEMI have multivessel coronary artery disease,1,4 and that

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