To the Editor:
Cantor et al. report that there is a significantly reduced rate of ischemic complications among patients with myocardial infarction with ST-segment elevation who are transferred for PCI within 6 hours after fibrinolysis. However, Table 2 of the article shows that significantly more patients in the group that underwent routine early PCI than in the group that received standard treatment received clopidogrel (P<0.001) or a beta-blocker (P=0.02).

The role of clopidogrel in reducing adverse cardiac events in patients who undergo PCI, as well as in those who do not, is well established,1,2 and clopidogrel has become part of the standard management of ST-segment elevation myocardial infarction. The benefit of beta-blockade — a reduction in ischemic complications — is also significant among patients with myocardial infarction, even when the possibility of an excess rate of cardiogenic shock with early beta-blocker therapy is taken into consideration.3 The overall benefit of clopidogrel and beta-blocker therapy could have influenced the outcome in patients who underwent early PCI. These facts leave the conclusion of the TRANSFER-AMI trial still highly uncertain.