title: Streptokinase antibodies in patients presenting with acute coronary syndrome in three rural New Zealand populations.
abstract: BACKGROUND
  New Zealand Māori have some of the highest rates of Group A streptococcal infection (GAS) in the world. GAS elevates titres of antistreptokinase (SK) neutralising antibodies and may induce resistance to SK.
  
  
  METHODS
  Anti-SK titres were measured in 180 patients presenting with symptoms consistent with an acute coronary syndrome to three New Zealand rural hospitals, selected because they provide care for patients from communities with different socio-economic and ethnic mixes (Māori proportions varying between 6% and 67%).
  
  
  RESULTS
  Compared with the community with the lowest proportion of Māori, patients in the community with the highest proportion of Māori had mean anti-SK titres that were 2.8 times higher (p=0.05). They were 2.5 times more likely to have a high anti-SK titre (33% vs 13% p=0.035).
  
  
  CONCLUSIONS
  Alternatives to reperfusion with SK should be the first-choice therapy in hospitals serving communities with high rates of GAS such as some predominantly Māori and Pacific Island communities.
authors.affiliation: Dunstan Hospital, Alexandra, New Zealand. garry.nixon@otago.ac.nz
authors.forename: Garry
authors.initials: G
authors.lastname: Nixon
authors.forename: Katharina
authors.initials: K
authors.lastname: Blattner
authors.forename: Jenny
authors.initials: J
authors.lastname: Dawson
authors.forename: Susan
authors.initials: S
authors.lastname: Dovey
authors.forename: Michael A
authors.initials: MA
authors.lastname: Black
authors.forename: Gerard
authors.initials: G
authors.lastname: Wilkins
authors.forename: Amy C
authors.initials: AC
authors.lastname: Dunn
authors.forename: Alexander D
authors.initials: AD
authors.lastname: McLellan
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology / Q000276:immunology; D000368:Aged; D000906:Antibodies / Q000097:blood*; D000075202:Contraindications; D005343:Fibrinolytic Agents / Q000276:immunology; D006801:Humans; D008875:Middle Aged; D009520:New Zealand; D012424:Rural Population; D013290:Streptococcal Infections / Q000276:immunology; D013297:Streptococcus pyogenes / Q000276:immunology; D013300:Streptokinase / Q000276:immunology
chemical_list: D000906:Antibodies; D005343:Fibrinolytic Agents; D013300:Streptokinase