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Grines et al. (1)reported randomization of patients with high-risk acute myocardial infarction (AMI) to one of two treatment strategies, namely transfer for primary percutaneous transluminal coronary angioplasty (PTCA) or on-site thrombolysis. Randomization required a mean of 44 min (median 32 min) and resulted in a mean delay of 63 min (median 51 min) from emergency room arrival to delivery of thrombolytic treatment. The time from symptom onset to emergency room arrival was not presented. This time interval is important for judging the impact of the reported treatment delay on mortality (2).
In addition, it would be interesting to know the proportion of patients eligible for the study, that is, the numbers of AMI patients screened, number of patients matching high-risk criteria, and number of those excluded.
- American College of Cardiology Foundation