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Moderne Koronarchirurgie in Zusammenhang mit der SYNTAX-Studie und aktuellen Leitlinien

Modern coronary surgery, the SYNTAX trial and updated guidelines

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Zusammenfassung

Die koronare Bypass-Operation ist ein modernes und sicheres Revaskularisationsverfahren und mehr denn je als Goldstandard bei fortgeschrittener koronarer Dreigefäßerkrankung anzusehen. In den Dreijahresergebnissen der SYNTAX-Studie zeigen sich neben der Überlegenheit bezüglich der Notwendigkeit einer erneuten Koronarrevaskularisation ein signifikanter Überlebensvorteil sowie ein niedrigerer Anteil an Myokardinfarkten für die chirurgisch behandelten Patienten im Vergleich zur PCI-Behandlung. Differenzierte Analysen zeigen deutliche Nachteile für die PCI bei zunehmender Komplexität der Koronarpathologie. Lediglich die anatomisch günstigen Formen von Hauptstammstenose oder koronarer Dreigefäßerkrankung scheinen mit interventionellen Methoden gleichermaßen behandelbar zu sein. Die Erkenntnisse aus der SYNTAX-Studie leiten eine neue Epoche in der Behandlung der KHK ein, in der, wie in den im Jahr 2010 aktualisierten Leitlinien der EACTS/ESC empfohlen wird, Interventionalist und Chirurg möglichst gemeinsam zu einem fundierten Therapievorschlag im Sinne eines „Heart-Team“-Konzepts für den betroffenen Patienten kommen.

Abstract

Coronary artery bypass grafting (CABG), a modern and safe procedure, is considered the therapy of choice in the care of patients with multi-vessel disease. The 3-year results of the SYNTAX trial not only showed surgical advantages in terms of repeat revascularisation, but the results also demonstrated significant surgical benefit for myocardial infarction and survival rates. More differentiated analyses showed distinct disadvantages in percutaneous coronary intervention (PCI) associated with the greater complexity of coronary pathology. PCI tends to be a comparable therapeutic option only in certain cases of left main stem lesions or multi-vessel disease. The findings from the SYNTAX study herald a new era in the treatment of coronary heart disease in which, as recommended in the updated guidelines issued by the EACTS/ESC in 2010, the interventionalist and the surgeon, working closely together as a“heart team”, provide a sound therapy plan for affected patients.

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  1. Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, 24105, Kiel, Deutschland

    A. Thiem, T. Attmann &  J. Cremer

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Correspondence to J. Cremer.

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Thiem, A., Attmann, T. & Cremer, J. Moderne Koronarchirurgie in Zusammenhang mit der SYNTAX-Studie und aktuellen Leitlinien. Herz 36, 669–676 (2011). https://doi.org/10.1007/s00059-011-3532-6

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