We thank Drs Kalyanasundaram, Kastrati and Berger for their interesting comments about our article.Patients included in our subgroup meta-analysis were not routinely scheduled for an early coronary revascularisation, so our results are not directly comparable with the ISAR trials. Patients did not receive clopidogrel as background medication at the time of admission, but almost all received dual antiplatelet treatment at the time of percutaneous coronary intervention (PCI). We agree that clopidogrel is recommended in patients with non-ST segment elevation ACS (NSTEACS) whether or not an invasive approach is planned. The concern, however, is the timing of clopidogrel administration, which continues to be debated, with many cardiologists electing to withhold clopidogrel until angiography because of concerns about bleeding with bypass surgery. This approach is consistent with the treatment strategy applied in the trials included in our meta-analysis.We agree that troponin-negative patients with moderate-to-high risk NSTEACS seem to have less benefit than troponin-positive patients, as we have shown in a previous post hoc subgroup analysis from our dataset. We acknowledge, however, [...
