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The authors' reply: We thank Dr Bisleri et al for their interest in our study and for their comments. However, we think that their comments are mostly based on misunderstandings.
The most fundamental misconception seems to be that of suspected case selection. Not all data can be shown in an article because of space considerations. Therefore we could not show that the vessel distribution and the segment distribution were not significantly different between the two types of hospitals. There is no geographical variation according to the severity of the lesions. Our population density is around 12% of that of Italy therefore to travel up to 400 km to a centre with surgical backup with or without an infarction is neither medically feasible nor possible in our medical system.
We feel that the data on mortality after emergency coronary artery bypass grafting (CABG) are clearly stated in the paper. The proportion of patients with a myocardial infarction who underwent emergency CABG did not differ between the two groups.
Although the tables depict non‐adjusted mortality, the text and fig 1 show the adjusted outcome. Hospital type (on‐site versus off‐site) was not a predictor of mortality.
We believe that our work clearly represents the general clinical situation of all patients undergoing percutaneous coronary intervention in Sweden—with a completeness of >99.9% for the mortality data thanks to the Swedish population registry. However, as already stated under limitations “Another possible shortcoming is the question of applicability of the Swedish data to other countries”. We mentioned that in Sweden no very low‐volume centres (<30 procedures/year) exist. Almost all percutaneous coronary intervention work is done on an ad hoc basis. Referral to other centres is the exception. Therefore, the data may not be applicable to Italy.