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Acute coronary syndromes: consensus recommendations for translating knowledge into action

Peter L Thompson
Med J Aust 2010; 193 (9): . || doi: 10.5694/j.1326-5377.2010.tb04047.x
Published online: 1 November 2010

In reply: Forge quotes the recommendation from the United States guidelines to consider conservative treatment after initial stabilisation of non-ST-elevation myocardial infarction.1 This may not the best option for patients in Australian regional hospital conditions. This pathway delivers less optimal outcomes1,2 and should only be considered if a seamless switch to an invasive approach can be made. The primary recommendation from the US guidelines for patients whose conditions are initially stabilised is that “an early invasive strategy . . . is indicated”.1


  • 1 Western Australia Heart Research Institute, Sir Charles Gairdner Hospital, Perth, WA.
  • 2 Coronary Care Manual, second edition, Elsevier, Sydney, NSW.



  • 1. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction. Circulation 2007; 116: e148-e304.
  • 2. Fox KA, Clayton TC, Damman P, et al; FIR Collaboration. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome: a meta-analysis of individual patient data. J Am Coll Cardiol 2010; 55: 2435-2445.
  • 3. de Winter RJ, Windhausen F, Cornel JH, et al; Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med 2005; 353: 1095-1104.
  • 4. Thygesen K, Mair J, Katus H, et al; the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care. Recommendations for the use of cardiac troponin measurement in acute cardiac care. Eur Heart J 2010; 31: 2197-2204.

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