Timing of Complete Revascularization for Myocardial Infarction

To the Editor: In the trial by Stähli et al. (Oct. 12 issue),¹ the results showing a benefit of immediate complete revascularization were driven by the risk of myocardial infarction (mostly periprocedural) and unplanned revascularization — arguably “soft” outcomes for a nonblinded clinical trial of percutaneous coronary intervention (PCI).² The causes of the unplanned coronary revascularization procedures, most of which were performed within the first 45 days, are not specified. Were these revascularization procedures urgent or elective, and were they clinically or ischemia-driven? If they were ischemia-driven, it would not have been relevant for the prognosis — whether revascularization was …