Perspective:

This is an interesting study using the BCIS PCI database. CGS is a big clinical problem, as it is a substantial reason for early death in ACS. I do not believe the findings from this study would be too surprising to most practicing interventional cardiologists. The clinical factors they identified are fairly consistent with the prior literature (with perhaps the exception of diabetes). The bottom line message is also a key point to keep in mind: We have a ways to go as far as this critical group of patients is concerned. However, two caveats that readers need to keep in mind when interpreting these data (which the authors readily acknowledge in their paper): 1) several key variables, such as receiving resuscitation and cardiac arrest, are unavailable in this database, while others are missing at moderately high rates; and 2) it is critical to understand that this cohort only included patients who arrived to the hospital and were selected for PCI. This last issue is not a minor point, as it represents only those individuals who were selected to undergo these procedures. As other papers have demonstrated, this selection can be heavily influenced by several factors including public reporting of individual operator or hospital outcomes for PCI.