Reply to Letter Regarding Article, "Weekend Onset of Acute Myocardial Infarction Does Not Have a Negative Impact on Outcome in Japan"(Author's Reply)

We thank Dr Mamkin and colleagues for their comment on our article. 1 The aim of our study was to assess clinical practice in Japan and patients’ outcomes. However, we also stressed that care should be taken when interpreting our findings. As we mentioned in the study limitations, although our multicenter study was prospective in nature, it included a smaller sample size than previous studies from North America. In addition, many confounding factors were not measured in our study, such as differences in patients’ backgrounds and the Japanese healthcare system, which could have influenced the outcome. These could be part of the uncertainties in clinical practice that influence our decision and thus patients’ outcomes. In our study, we tried to adjust for these factors appropriately, although one cannot deny that any such adjustment cannot be always perfect. To find practical and positive solutions for these issues, the ideal study should be prospective in nature and include sufficient number of patients so as to reduce any possible bias and chances of random errors. Now that we have data from different countries, we await better studies that include larger population samples drawn from various countries. We expect that every practicing physician in all countries genuinely provides the best clinical service to patients regardless of their clinical conditions. No doubt, each case and experience is different and peculiar, but collectively, the medical profession could contribute to improvement of quality of care. Towards this goal, as Dr Mamkin and colleagues alluded to, physicians worldwide should work cooperatively to improve the outcome of various medical conditions, including acute myocardial infarction.