ATLAS: Another Negative Trial With a Positive-Sounding Acronym
To the Editor:
The excellent report by Singh et al1 on the ATLAS trial brings up an issue that some readers may not be cognizant of. The issue is that of a negative trial with a positive-sounding acronym. Atlas, of course, was powerful enough to support the world on his shoulders. Consequently, in this trial, the acronym ATLAS (Acolysis during Treatment of Lesions Affecting Saphenous vein bypass grafts) immediately connotes something powerful and positive. This connotation, in turn, is likely to favorably influence or coerce both the investigators and those being investigated.2 The trial, however, fails to demonstrate any benefit of coronary ultrasound thrombolysis over abciximab with a lower procedural success and a higher incidence of postprocedure myocardial infarction.
There are many other positive-sounding, potentially coercive, acronyms of trials that turned out to yield negative results, such as ALIVE, CARDINAL, HALT-MI, IMPROVED, LIMIT AMI, MIRACLE, PROMISE, SAVED, and SWORD (for definitions of these acronyms, please consult Cheng and Julian3). I hope that researchers, sponsors, and institutional review boards will keep in mind the potentially coercive nature of certain trial acronyms and will discourage or prohibit their use.