Apparently, Pérez de Prado et al continue to appreciate our scientific contributions.1,2 Concerning our latest article, they express their opinion—we would say with too visceral an attitude and taking no notice of the important methodological details of our study—that we make use of a sensationalist title.2
The original title of the article was “Medium- to Long-term Risk of Infarction, Stroke, or Cardiovascular Death Following Acute Coronary Syndrome. Incidence and Development of Predictive Tools”. The editors of Revista Española de Cardiología considered the present title to be more appropriate; we accepted.
Thus, we are surprised by the letter and its style, and would like to enlighten its authors about 2 basic methodological facts. When studies and procedures are highly prevalent in a population (as is the case with revascularization in our article, with a prevalence of ˜ 70%), they may not emerge as prognostic determinants during a phase of the study. On the other hand, our study was conducted in a heterogeneous population with different levels of risk for the composite event of reinfarction (quantitatively, it represented the major component of the composite event), stroke, or cardiovascular death. Under these conditions, our observation should not come as a surprise. For example, in the population of patients with myocardial infarction included in the multicenter TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status) registry, recruited in 24 hospitals in the United States, in-hospital percutaneous revascularization was even associated with a higher adjusted risk of rehospitalization for an acute coronary syndrome (hazard ratio = 1.85; 95% confidence interval, 1.28-2.69; P = .001) after 1 year of follow-up.3 Therefore, we consider it unfortunate that the authors, in their comment, failed to differentiate between effectiveness (impact resulting from an action carried out under the usual conditions) and efficacy (impact on health status of an action carried out under optimal conditions or under ideal conditions for its use and application) for a correct interpretation of our study. Finally, we should point out that the fact that a treatment does not completely resolve a problem is not synonymous with therapeutic nihilism.
CONFLICTS OF INTERESTE. Abu-Assi is a member of the editorial team of Revista Española de Cardiología.