Seasonal distribution of myocardial infarction and seasonal mood changes.

نویسنده

L Sher

چکیده

REPLY We thank Kok, Umans, and Arnold for their statistical calculations. Indeed, a large sample size would be required to prove that there is equivalence in clinical outcome between patients directly admitted compared to transferred patients. To demonstrate that the six-month mortality rate would not exceed more than 1% (6% vs. 7%) would require a sample size of even more than 25,000 patients! However, it was not our objective to prove that transferred patients have an identical clinical outcome compared with directly admitted patients. The “primary endpoints” of this analysis were variables such as ejection fraction, enzymatic infarct size and patency rate. For completeness, six-month mortality and reinfarct rates were reported, demonstrating that the delay was indeed not associated with a strong increase of adverse events. However, we emphasize the importance of the patency rate achieved in the referral patients for longterm survival (1,2), and therefore, our data are compatible with equivalence in clinical outcome, albeit without the statistical proof. The second question regards data on the subgroup of patients admitted between 3 h and 6 h following onset of symptoms. As described in our article, one of the characteristics of referral patients is the short delay between onset of symptoms and admission. This is probably caused by the criteria used by referral cardiologists for the decision to transport the patient for primary angioplasty. In the study group, therefore, only 43 patients presented between 3 h to 6 h following onset of symptoms. This subset of patients is too small to be separately evaluated.

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