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Guidelines for the management of acute coronary syndromes 2006

Philip Aylward, Constantine N Aroney, Ken Hossack and Andrew M Tonkin
Med J Aust 2006; 185 (5): 294-295.
Published online: 4 September 2006

In reply: As Bezzina states, the GUSTO-I trial is the main source of evidence for the superiority of front-loaded alteplase (rt-PA) over streptokinase, showing a 1% absolute and 15% relative benefit.1 Subgroup analysis suggested that only certain groups benefited, but this is an inappropriate use of subgroups, and the result should be applied overall. A clear mechanistic reason for the advantage of rt-PA — greater 90-minute full coronary patency — has also been demonstrated.2

  • Philip Aylward1
  • Constantine N Aroney2
  • Ken Hossack3
  • Andrew M Tonkin4

  • 1 Flinders Medical Centre, Adelaide, SA.
  • 2 Holy Spirit Northside Hospital, Brisbane, QLD.
  • 3 Cardiac Society of Australia and New Zealand, Sydney, NSW.
  • 4 National Heart Foundation of Australia, Melbourne, VIC.


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