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Vol. 58. Issue 4.
Pages 458 (April 2005)
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Vol. 58. Issue 4.
Pages 458 (April 2005)
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DOI: 10.1016/S1885-5857(06)60680-4
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Vicent Bodía, Juan Sanchisa, Julio Núñeza, Ángel Llácera
a Servicio de Cardiología, Hospital Clínico y Universitario,
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To the Editor:

We are sincerely grateful for the comments and interest shown by de la Hera et al with regard to our original article published in the Revista Española de Cardiología.1 We would very much like to emphasize our wholehearted agreement with the authors.

Although they refer to a limited group of 30 patients, the data presented by de la Hera et al open our eyes to the existence of another and, if we might say so, an even more real world. The fact that in this very high risk group of patients (>13% in-hospital mortality) fewer than half undergo coronary angiography (despite the hospital's recommendation for invasive management) should raise a number of questions. Doubtless, the fundamental objective has to be the direct involvement (still beyond a distant horizon in some parts of the country and contexts) of the cardiologist in the management of these patients throughout and especially in the decision-making process.

In any case, we should not flinch from being self-critical:

 

1. Cardiac catheterization laboratories have to provide maximal services to clinical cardiologists in provincial hospitals in order to program and treat their unstable patients, preferably during hospitalization.

2. Sufficient evidence is already available for us to affirm that in patients with non-ST elevation acute coronary syndrome and high risk criteria it is best to initiate standard treatment and program revascularization prior to discharge, wherever they may be. It would be wise to encourage colleagues in centers without cardiac catheterization laboratories to avoid "self-censorship" or an excessively conservative management of patients with a more unstable profile.

We hope that the excellent scientific initiatives put forward to improve attention to our patients2 will receive sufficient Government support for them to become a practical reality.

Bibliography
[1]
Bodí V, Sanchis J, Llácer A, Fácila L, Núñez J, Pellicer M, et al..
Estrategia invasiva en el síndrome coronario agudo sin elevación del segmento ST. De los grandes estudios al mundo real..
Rev Esp Cardiol, 57 (2004), pp. 1143-50
[2]
Disponible en: www.msc.es
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Revista Española de Cardiología (English Edition)

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