To the Editor In a recent multicenter investigation, Hillerson et al1 highlighted important disparities in ST-segment elevation myocardial infarction management between those residing in rural vs urban settings. The lack of observed differences in outcome measures among these settings, despite the measured variations in process metrics, is encouraging and may be an indicator of progress in providing equitable care in hospitals. However, the probable exposure misclassification raises concerns regarding the internal validity of the results. I commend the authors for appreciating the limitations of their analysis, yet the definition of rurality applied should be further recognized given the importance of rural-urban dichotomization in the study design.