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Improving outcomes in coronary artery disease

Andrew I MacIsaac
Med J Aust 2016; 205 (3): . || doi: 10.5694/mja16.00656
Published online: 1 August 2016

Systems, procedures and policies are needed to further reduce the toll of cardiovascular disease

Although major advances have been made in many aspects of the treatment of heart disease, rates of mortality and morbidity from acute coronary syndromes (ACS) in Australia and New Zealand remain significant. The SNAPSHOT ACS study reported outcomes of patients presenting with ACS.1 The 18-month mortality for patients presenting with an ST-elevation myocardial infarction was 16.2%, 16.3% for those presenting with a non-ST-elevation myocardial infarction, and 6.8% for those with unstable angina. Although these outcomes are a substantial advance on historical data, there is still much room for improvement.2 It is therefore timely that the National Heart Foundation (NHF) and the Cardiac Society of Australia and New Zealand (CSANZ) have revised the Australian guidelines for the management of ACS (summarised in this issue of the MJA).3 The NHF, CSANZ and all involved should be congratulated on the development of these guidelines.


  • 1 Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, VIC
  • 2 Guest Editor, MJA Cardiology issue


Correspondence: andrew.macisaac@svha.org.au

Competing interests:

No relevant disclosures.

  • 1. Chew DP, French J, Briffa TG, et al. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Med J Aust 2013; 199: 185-191. <MJA full text>
  • 2. Australian Institute of Health and Welfare. Australian facts 2011 (AIHW Cat. No. CVD 53: Cardiovascular Disease Series No 35) Canberra: AIHW, 2011. http://www.aihw.gov.au/publication-detail/?id=10737418510 (accessed May 2016).
  • 3. Chew DP, Scott IA, Cullen L, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Med J Aust 2016; 205: 128-133.
  • 4. Denktas AE, Anderson HV, McCarthy J, et al. Total ischemic time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care. JACC Cardiovasc Interv 2011; 4: 599-604.
  • 5. Hutchison A, Malaiapan Y, Barger B, et al. Field 12 lead ECG and ED activation of the infarct team in STEMI improves door to balloon times: an update of the MonashHEART acute myocardial infarction (Mon-AMI) 12 lead project. Heart Lung Circ 2009; 18: S200.
  • 6. Bray JE, Stub D, Ngu P, et al. Mass media campaigns’ influence on prehospital behavior for acute coronary syndromes: an evaluation of the Australian Heart Foundation’s warning signs campaign. J Am Heart Assoc 2015; 4: e001927.
  • 7. Khan AA, Williams T, Savage L, et al. Pre-hospital thrombolysis in ST-segment elevation myocardial infarction: a regional Australian experience. Med J Aust 2016; 205: 121-125.
  • 8. Baggoley C, Owler B, Grigg M, et al. Expert panel review of elective surgery and emergency access targets under the National Partnership Agreement on Improving Public Hospital Services. Report to the Council of Australian Governments, 30 June 2011. Canberra: Commonwealth of Australia, 2011. https://www.coag.gov.au/sites/default/files/Expert_Panel_Report%20D0490.pdf (accessed May 2016).
  • 9. May AN, Kull A, Gunalingam B, et al. The uptake of coronary fractional flow reserve in Australia in the past decade. Med J Aust 2016; 205: 127.
  • 10. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 2007; 49: 2105-2111.
  • 11. De Bruyne B, Fearon WF, Nico HJ, et al. Fractional flow reserve–guided PCI for stable coronary artery disease. N Engl J Med 2014; 371: 1208-1217.
  • 12. Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2014; 35: 2541-2619.
  • 13. Smith SC Jr, Benjamin EJ, Bonow RO, et al. World Heart Federation and the Preventive Cardiovascular Nurses Association. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124: 2458-2473.
  • 14. Shore S, Jones PG, Maddox TM, et al. Longitudinal persistence with secondary prevention therapies relative to patient risk after myocardial infarction. Heart 2015; 101: 800-807.
  • 15. Gallagher R, Neubeck L. How health technology helps promote cardiovascular health outcomes. Med J Aust 2016; 205: 107-108.
  • 16. Australian Commission on Safety and Quality in Health Care. Acute Coronary Syndromes Clinical Care Standard. Sydney: ACSQHC, 2014. http://www.safetyandquality.gov.au/our-work/clinical-care-standards/acute-coronary-syndromes-clinical-care-standard (accessed May 2016).

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