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[Correspondence] STREAM characterisation correction – Authors’ reply

We greatly appreciate the thoughtful response to our Seminar by Paul Armstrong and Frans Van de Werf. In our Seminar (Jan 14, p 197),1 we cite the Strategic Reperfusion Early after Myocardial Infarction (STREAM) study to support the statement that immediate or very early percutaneous coronary intervention (PCI) after fibrinolytic therapy has no ischaemic benefit and might cause harm by increasing bleeding.2 We feel that this is a justified application of this reference, because in STREAM, a greater proportion of patients who had intracranial haemorrhage in the fibrinolysis group was recorded compared with the proportion in the primary PCI only group (1·0% vs 0·2%; p=0·04), particularly in patients older than 75 years of age.

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