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The very best that...
The very best that retrospective analysis of registry data can achieve is a hypothesis. If we didnt already have numerous randomised trials in NSTEMI and in STEMI then the analysis might suggest it would be good idea to do one, but to suggest that a retrospective case control study has anything at all to contribute to the debate on the benefits of PCI in ACS above the randomised trials is statistical nonsense.
Furthermore their claim that it reinforces clinical trial data is incorrect. Clinical trial data in repeated studies and metaanalyses has shown no mortality benefit for routine early PCI in NSTEMI2,3. As far as STEMI is concerned the data does not appear to include timeliness of thrombolysis or PCI, and this is more important than which intervention is received.
Their study does raise the possibility that beta blockers are not helpful but we dont know why they were withheld so a randomised trial should be considered to answer this question. A registry study cannot.
1. D P Chew, F A Anderson, A Avezum, K A Eagle, G Fitzgerald, J M Gore, R Dedrick, D Brieger, for the GRACE Investigators. Six-month survival benefits associated with clinical guideline recommendations in acute coronary syndromes. Heart hrt.2009.184853 Published Online First: 7 June 2010 doi:10.1136/hrt.2009.184853
2. ODonoghue M, Boden WE, Braunwald E, et al. Early invasive vs
conservative treatment strategies in women and men with unstable
angina and non-ST-segment elevation myocardial infarction: a metaanalysis.
JAMA 2008; 300: 71-80.
3. Peters RJ, Mehta S, Yusuf S. Acute coronary syndromes without ST
segment elevation. BMJ 2007; 334: 1265-1269.