We thank Drs De Servi and Navarese for their interest in our study. Their question draws attention to the fact that the causes of death in patients with acute coronary syndromes are multifactorial, due to (1) the acute disease state itself; (2) underlying comorbidities; (3) the success of therapies; and (4) complications arising after initial presentation, either due to the underlying disease or as a consequence of therapeutic interventions. Indeed, as stated in the article,1 only 109 of 524 (21%) deaths in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial occurring by 1 year were attributable to myocardial infarction (MI) or major bleeding. Thus, either a larger sample size, higher baseline mortality rate, or greater proportion of deaths due to the postprocedural complications of ischemia and bleeding would be required for the relative benefits of bivalirudin compared with heparin plus glycoprotein IIb/IIIa inhibitors to result in a statistically significant reduction in mortality. Such a benefit was in fact seen in the Harmonizing Outcomes with Revascularization and Stents …