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Restoration of flow in acute coronary obstructive syndromes: consequences of different management strategies.

Although much necessary evidence is not yet available, there is sufficient information from recent therapeutic trials to necessitate a nationwide review of the management of acute coronary obstructive syndromes. On the basis of present information it is evident that, in addition to heparin, all patients suffering from suspected acute myocardial infarction should receive immediate low dose aspirin which should be continued for one to six months. This treatment, if generally applied, can be expected to save 1200 lives per year in Canada at negligible cost. Addition of intravenous streptokinase infusion to all patients (in whom there are no contraindications) available for treatment from 0 to 24 h from the onset, can be expected to save an additional 1088 lives at an additional cost of approximately $11,000 per life. Other thrombolytic agents involve additional cost and the gains in terms of mortality are not yet demonstrated. The evidence for thrombolytic treatment in acute unstable angina is still uncertain but the treatment of all cases with aspirin from the earliest possible moment is clearly indicated.