2007 addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Guidelines for the management of acute coronary syndromes 2006

Constantine N Aroney, Philip Aylward, Derek P Chew, Nancy Huang, Anne-Maree Kelly, Harvey White and Michelle Wilson
Med J Aust 2008; 188 (5): 302-303. || doi: 10.5694/j.1326-5377.2008.tb01626.x
Published online: 3 March 2008

Results from recently published clinical trials provide additional information to be considered in the choice of therapies in the management of acute coronary syndromes. This addendum summarises the important findings and their implications for recommended practice.

Reperfusion and revascularisation for ST-segment-elevation myocardial infarction
Important findings
Antiplatelet and antithrombin therapy

Recent evidence, while providing additional information on outcomes for individual agents, does not provide conclusive evidence of the superiority of one agent over another, nor of one combination of therapies over another. The risks and benefits of these therapies and strategies should be evaluated individually in each patient.

Important findings
Implications of the findings
  • Constantine N Aroney1
  • Philip Aylward2
  • Derek P Chew2,3
  • Nancy Huang4
  • Anne-Maree Kelly5,6
  • Harvey White7
  • Michelle Wilson4

  • 1 Cardiac Services, Holy Spirit Northside Hospital, Brisbane, QLD.
  • 2 Flinders Medical Centre, Adelaide, SA.
  • 3 Flinders University, Adelaide, SA.
  • 4 National Heart Foundation of Australia, Melbourne, VIC.
  • 5 Department of Emergency Medicine, Western Hospital, Melbourne, VIC.
  • 6 Joseph Epstein Centre for Emergency Medicine Research, Melbourne, VIC.
  • 7 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.

Competing interests:

Constantine Aroney has received speaker fees from CSL. Philip Aylward has received research honoraria, speaker fees or travel assistance from TIMI Group (Harvard University), VIGOUR Group (Duke University), Pfizer, AstraZeneca, Eli Lilly, Boehringer Ingelheim and Sanofi-Aventis, and is a member of advisory boards to AstraZeneca, Sanofi-Aventis, Eli Lilly, CSL, Boehringer Ingelheim, and Pfizer. Derek Chew has received speaker fees from CSL and Sanofi-Aventis. Anne-Maree Kelly is a member of an advisory board to Sanofi-Aventis. Harvey White has received research grants, consulting fees or speaker fees from Sanofi-Aventis, Eli Lilly, Medicines Company, NIH, GlaxoSmithKline, Pfizer, Roche, Johnson & Johnson, Schering-Plough, Merck Sharpe & Dohme, Novartis, AstraZeneca, Boehringer Ingelheim, Servier Laboratories, Wyeth Ayerst, and Bayer.

  • 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. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med 2005; 353: 2758-2768.
  • 3. Wijeysundera HC, Vijayaraghavan MD, Brahmajee K, et al. Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction. A meta-analysis of randomized trials. JACC 2007; 49: 422-430.
  • 4. Hochman JS, Lamas GA, Buller CE, et al. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med 2006; 355: 2395-2407.
  • 5. Antman EM, Morrow DA, McCabe CH, et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006; 354: 1477-1488.
  • 6. The OASIS-6 Trial Group. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-elevation myocardial infarction. The OASIS-6 randomized trial. JAMA 2006; 295: 1519-1530.
  • 7. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354: 1464-1476.
  • 8. Stone GW, McLaurin BT, Cox DA, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med 2006; 355: 2203-2216.
  • 9. Kastrati A, Mehilli J, Neumann FJ, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA 2006; 295: 1531-1538.
  • 10. Stone GW, Bertrand ME, Moses JW, et al. Routine upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes. JAMA 2007; 297: 591-602.


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