RT Journal
A1 Ting HH, Nallamothu BK, Krumholz HM
T1 PErcutaneous intervention for non–st-segment elevation myocardial infarction within the therapeutic time window for acute myocardial infarction—reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD May 23
VO 171
IS 10
SP 941
OP 954
DO 10.1001/archinternmed.2011.192
UL http://dx.doi.org/10.1001/archinternmed.2011.192
AB 
 refers to the disparate benefit in mortality observed with immediate reperfusion (emphasizing the timing of such therapy) for patients with STEMI vs non-STEMI. For STEMI, immediate reperfusion with primary PCI and door-to-balloon time of less than 90 minutes improves survival.2- 3 We have previously demonstrated that longer prehospital delay in patients with STEMI was associated with higher in-hospital mortality.4 For non-STEMI, however, available data are less clear owing to the heterogeneous patient populations. Two recent randomized trials investigating early vs delayed PCI failed to show benefit from early intervention. The Timing of Intervention in Acute Coronary Syndrome (TIMACS) trial compared early vs delayed intervention (median time from randomization to PCI, 16 hours vs 56 hours) showed comparable rates of death at 6 months (4.8% vs 5.9%; P = .19) as well as death, myocardial infarction, or stroke at 6 months (9.6% vs 11.3%; P = .15).5 The Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention (ABOARD) study compared immediate vs early intervention (median time from randomization to sheath insertion, 70 minutes vs 21 hours) demonstrated similar peak troponin levels during the index hospitalization as well as death, myocardial infarction, or urgent revascularization at 1 month (13.7% vs 10.2%; P = .31).6 Current trials do not establish that early or immediate intervention for patients with non-STEMI improve survival, as has been shown for patients with STEMI.