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Guidelines for the management of acute coronary syndromes 2006

Andrew J Bezzina
Med J Aust 2006; 185 (5): . || doi: 10.5694/j.1326-5377.2006.tb00569.x
Published online: 4 September 2006

To the Editor: The discussion of fibrinolysis in the recently published guidelines for the management of acute coronary syndromes 20061 is interesting. The recommendations clearly indicate that second-generation agents should be preferred to streptokinase in all circumstances. The guidelines reference the GUSTO-I trial data2 as the primary support for those recommendations. These data are, at best, debatable in terms of showing any benefit of front-loaded tissue plasminogen activator over streptokinase, and then only in limited circumstances (ie, patients aged less than 75 years with anterior infarcts and within 4 hours of the onset of symptoms).3,4


  • Wollongong Hospital, Wollongong, NSW.



  • 1. Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184 (8 Suppl): S1-S32. <MJA full text>
  • 2. The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673-682.
  • 3. Ridker PM, O’Donnell C, Marder VJ, Hennekens CH. Large-scale trials of thrombolytic therapy for acute myocardial infarction: GISSI-2, ISIS-3, and GUSTO-1. Ann Intern Med 1993; 119: 530-532.
  • 4. Brophy JM, Joseph L. Placing trials in context using Bayesian analysis: GUSTO revisited by Reverend Bayes. JAMA 1995; 273: 871-875.

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