• EBM
• Quality of Care and Outcomes

Terkelsen et al imply that the guidelines have distorted the evidence, particularly with respect to acceptable delays in delivering percutaneous coronary intervention (PCI), in order to favour prehospital thrombolysis over primary PCI as the recommended reperfusion strategy for STEMI, and that doing so will deprive patients from lifesaving treatment.

This is a complete misinterpretation and misrepresentation of the guidelines. First, the guidelines clearly favour primary PCI and state “Primary PCI (...) is the preferred reperfusion strategy in patients with STEMI”. Secondly, the guidelines do not suggest thrombolysis over PCI if the PCI delay is 60 min, but in fact state (in several locations) that a “PCI related delay of 120 min is useful in selecting primary PCI over immediate thrombolysis as the preferred mode of reperfusion”. This statement clearly reflects the choice of the committee to favour primary PCI for reperfusion and the fact that, contrary to the statement of Terkelsen et al, the guidelines do not “reduce the window of opportunity for primary PCI”. However, the guidelines also emphasise that the decision to choose primary PCI over thrombolysis should not lead to complacency with respect to delays; this is …