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Interventionelle Therapie des akuten Herzinfarkts

Interventional therapy of acute myocardial infarction

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Zusammenfassung

Der akute Myokardinfarkt wird heute in einen ST-Hebungsinfarkt (STEMI) und einen Nicht-ST-Hebungsinfarkt (NSTEMI) eingeteilt. Für die Praxis bedeutsamer, da sich alle Empfehlungen der Leitlinien bzgl. des invasiven Vorgehens danach richten, ist aber die Einteilung in ein akutes Koronarsyndrom mit ST-Hebungen (STE-ACS = STEMI) und eines ohne ST-Hebungen (NSTE-ACS). Letzteres wird nochmals unterteilt in ein NSTE-ACS mit oder ohne Risikomerkmale. Für das NSTE-ACS mit Risikomerkmalen wird allgemein eine frühe invasive Abklärung innerhalb von 72 h nach Diagnosestellung empfohlen, während das NSTE-ACS ohne Risikomerkmale zunächst rein medikamentös konservativ behandelt werden kann. Bezüglich des STEMI ist die Primärdilatation eindeutig Mittel der Wahl, wenn sie innerhalb von 2 h nach Diagnosestellung an einem erfahrenen Interventionszentrum mit kurzen Pforte-Ballon-Zeiten durchgeführt werden kann. Da dies in Deutschland prinzipiell flächendeckend möglich ist, ist es zurzeit die primäre Aufgabe, lokale Netzwerke zu errichten, um dies zu gewährleisten.

Abstract

Currently an acute myocardial infarction has to be differentiated into ST-elevation myocardial infarction (STEMI) or non ST-elevation myocardial infarction (NSTEMI). However, there exists another definition of acute coronary syndromes (ACS), which is more important in clinical practice, for all recommendations from the guidelines of the cardiac societies concerning the invasive strategies rely on this one. Here one has to differentiate an ACS with ST-elevation (STE-ACS = STEMI) from an ACS without ST-elevation (NSTE-ACS). The last one is further divided into an NSTE-ACS with or without high risk. In patients with an NSTE-ACS with high risk an early invasive strategy is recommended within 72 h after the diagnosis. In patients with an NSTE-ACS without high risk a more conservative approach can be pursued. In STE-ACS patients primary angioplasty is the reperfusion therapy of choice, if it can be performed in a timely fashion within 2 h after diagnosis at an interventional centre with experienced interventionalists and short “door-to-balloon” times. In Germany this goal is achievable almost everywhere. Therefore it is currently the most important task to establish local networks to reach this goal.

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  1. Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Herzzentrum Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Deutschland

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Zahn, R., Zeymer, U. Interventionelle Therapie des akuten Herzinfarkts. Internist 49, 1038–1046 (2008). https://doi.org/10.1007/s00108-008-2075-2

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