To the Editor In their recently published elegant article,1 Padfield et al have reported potential cardiovascular effects of tumour necrosis factor α (TNF-α) antagonism in patients with non-ST elevation acute myocardial infarction. In this first in human study, the authors have demonstrated that a single dose of etanercept (a TNF-α antagonist) infusion might blunt systemic inflammatory response, but might appear to enhance platelet aggregation along with its neutral effects on fibrinolytic and peripheral vasomotor functions in these patients 24h after infusion suggesting that TNF-α antagonism should not be regarded as a promising therapeutic strategy in the setting of acute myocardial infarction (AMI).1 We also agree that currently, this strategy should be regarded with caution in the setting of acute coronary syndrome (ACS). However, as described below, based on the multifaceted nature of systemic inflammation and its detrimental effects, modulation of cytokine response in conditions with heightened …