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Immediate versus deferred coronary angioplasty in non-ST-elevation acute coronary syndromes
Lancashire Cardiac Centre, BFW Hospitals NHS Trust, Blackpool, UK
Correspondence to:
Correspondence to Dr A Kumar, Department of Cardiology, Lancashire Cardiac Centre, BFW Hospitals NHS Trust, Whinney Heys Road, Blackpool FY3 8NR, UK; dr.kumar2@bfwhospitals.nhs.uk
| The first 150 words of the full text of this article appear below. |
To the editor: Riezebos et al1 should be commended for trying to define the optimal timing of early coronary intervention (percutaneous coronary intervention) in patients with non-ST elevation acute coronary syndrome (ACS), an area that lacks robust evidence. However, we believe there are some deficiencies in their study that may alter the conclusions.
Although the recruitment was done at "three high-volume centres", the slow recruitment and small population size raise the question as to whether the patients were carefully selected, excluding other patients with ACS who might have benefited from early intervention. Further, some authors have previously questioned the use of creatine kinase (CK)-MB in defining the end point in this setting.2 Any rise in CK-MB after the procedure does reflect myocardial necrosis but to what extent minor rises (
1x the upper limit of normal) correlate with myocardial damage is questionable. This may well reflect higher baseline risk
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