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Streptokinase antibodies in patients presenting with acute coronary syndrome in three rural New Zealand populations
  1. Garry Nixon1,2,
  2. Katharina Blattner2,3,
  3. Jenny Dawson4,
  4. Susan Dovey2,
  5. Michael A Black5,
  6. Gerard Wilkins6,
  7. Amy C Dunn7,
  8. Alexander D McLellan7
  1. 1Dunstan Hospital, Alexandra, New Zealand
  2. 2Department of General Practice and Rural Health University of Otago, Dunedin, New Zealand
  3. 3Hokianga Health Enterprise Trust, Rawene, New Zealand
  4. 4Thames Hospital, Thames, New Zealand
  5. 5Department of Biochemistry, University of Otago, Dunedin, New Zealand
  6. 6Department of Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand
  7. 7Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
  1. Correspondence to Dr Garry Nixon, Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, P O Box 913, Dunedin 9054, New Zealand; garry.nixon{at}


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%).

Findings 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).

Interpretation 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.

  • Antibodies
  • cardiovascular
  • myocardial ischaemia

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  • Funding The Heart Foundation; The Healthcare Otago Charitable Trust.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the New Zealand Multi-Region Ethics Committee, New Zealand Ministry of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.