To the editor: We read with interest the study by Dr Gale and colleagues.1 We fully agree with the authors that age, heart rate and systolic blood pressure are among the most powerful prognosticators in acute coronary syndromes (ACS).2 3 However, we believe that several key points deserve clarification.

First, by dichotomising continuous variables such as creatinine and Killip class (eg, Killip class II and IV would both be considered equivalent to “cardiac failure”), substantial prognostic information would be lost, so that performance of risk scores consisting of such variables would …