Has Prasugrel Been Compared Correctly With Clopidogrel in Non–ST-Segment Elevation Acute Coronary Syndrome?

We thank Dr. Matsoukis and colleages for their letter expressing an interest in our recent study (1). Regarding the type of drug-eluting stents (DES) (first vs. second generation), 72% of the stents used in the propensity-matched DES/coronary artery bypass graft (CABG) pairs were second-generation DES, with the others being first-generation DES. When the pairs were limited to second-generation DES compared with CABG surgery, there were still no significant differences for mortality or for mortality/myocardial infarction/stroke. Repeat revascularization rates were again lower for CABG surgery, and the adjusted hazard ratio (AHR) was very similar to the AHR for all pairs (0.60 vs. 0.54 for all pairs). It is possible that our results could have been different if we had used cardiac mortality instead of all-cause mortality, but unfortunately we did not have access to that measure. It is not true that CABG surgery was associated with a significantly lower rate when we looked at the composite endpoint of mortality/myocardial infarction/stroke. As the letter states, we found the AHR to be 0.96 (95% confidence interval: 0.86 to 1.06), which is not significant because the confidence interval includes the number 1.