Abstract
Tarantini et al.1 concluded that "patients with a mortality risk <4.5% are unlikely to obtain a survival benefit by p-PCI compared with TL". This is, however, an oversimplification.
It was repeatedly shown that even patients with low mortality risk (e.g. young patients with inferior STEMI) have better outcomes with p-PCI compared with TL. The apparent lack of benefit (from p-PCI) is caused only by the lack of statistical power in low risk subgroups.
Concerning the baseline risk, there is no single subgroup of STEMI patients showing benefit from TL compared with p-PCI. Patients in all baseline risk subgroups do benefit from p-PCI; the statistical power of this benefit is weak in low risk subgroups due to mathematical (not medical) reasons.
While the absolute mortality difference (p-PCI vs. TL) decreases with decreasing baseline risk, the relative mortality benefit from p-PCI remains similar across all baseline risk subgroups.