Zusammenfassung
Die 2013 veröffentlichten ESC (Europäische Gesellschaft für Kardiologie)-Leitlinien zur stabilen koronaren Herzerkrankung geben praktische Hinweise zum Einsatz diagnostischer Verfahren zur Erkennung einer hämodynamisch relevanten koronaren Herzerkrankung und zur langfristigen Verlaufskontrolle von mittlerweile asymptomatischen Patienten mit chronischer koronarer Herzkrankheit (KHK). Die Auswahl geeigneter diagnostischer Verfahren basiert auf der Vortestwahrscheinlichkeit, die eine zentrale Rolle im diagnostischen Algorithmus einnimmt. Nur bei Patienten mit schwerer Angina oder einem hohem Risiko für Tod oder Myokardinfarkt nach Risikostratifikation wird zu einem direkten invasiven Vorgehen geraten. Therapeutisch wird ein Schema zum Einsatz antianginöser und präventiver Medikamente vorgegeben, das neue Antianginosa einbezieht. Die Indikation zur perkutanen Koronarintervention (PCI) wird insbesondere für Patienten mit niedrigem SYNTAX-Score und Mehrgefäßerkrankung oder Hauptstammstenose erweitert.
Abstract
The 2013 guidelines of the European Society of Cardiology (ESC) on the management of stable coronary artery disease (CAD) give practical recommendations for the use of diagnostic tools to identify hemodynamically relevant coronary artery stenoses. Furthermore, they give advice for the management of previously symptomatic patients with known obstructive or non-obstructive CAD, who have become asymptomatic with treatment and need regular follow-up. The selection of appropriate diagnostic tests is based on the tabulated pretest probability of the patient, which plays a central role in the diagnostic algorithm. An invasive approach is recommended only for patients who either have severe angina or who are judged to be at high risk for adverse events based on clinical evidence or the results of diagnostic tests. The optimal use of preventive and antianginal medications is shown in a scheme which includes the new antianginal drugs. The guidelines recommend a percutaneous coronary intervention (PCI) as an alternative to bypass surgery in patients with multivessel disease or left main stem stenosis if the SYNTAX score is low.
Literatur
Montalescot G, Sechtem U, Achenbach S et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34(38):2949–3003
Fox K, Garcia MA, Ardissino D et al (2006) Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the management of stable angina pectoris of the European Society of Cardiology. Eur Heart J 27(11):1341–1381
National Institute for Health and Clinical Excellence (2010) Chest pain of recent onset (Clinical guideline 95). http://guidance.nice.org.uk/CG95., http://www.nice.org.uk/guidance/CG95
Fihn SD, Gardin JM, Abrams J et al (2012) 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 60(24):e44–e164
Genders TS, Steyerberg EW, Alkadhi H et al (2011) A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 32(11):1316–1330
Diamond GA, Forrester JS (1979) Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 300(24):1350–1358
Genders TS, Steyerberg EW, Hunink MG et al (2012) Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ 12;344:e3485. doi: 10.1136/bmj.e3485
Chung SC, Hlatky MA, Faxon D et al (2011) The effect of age on clinical outcomes and health status BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes). J Am Coll Cardiol 58(8):810–819
Press Release. European Medicines Agency recommends measures to reduce risk of heart problems with Corlentor/Procoralan (ivabradine)
Kosiborod M, Arnold SV, Spertus JA et al (2013) Evaluation of ranolazine in patients with type 2 diabetes mellitus and chronic stable angina: results from the TERISA randomized clinical trial (Type 2 Diabetes Evaluation of Ranolazine in Subjects With Chronic Stable Angina). J Am Coll Cardiol 61(20):2038–2045
Wijns W, Kolh P, Danchin N et al (2010) Guidelines on myocardial revascularization. Eur Heart J 31(20):2501–2555
Windecker S, Kolh P, Alfonso F et al (2014) 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35(37):2541–2619
Group BDS, Frye RL, August P et al (2009) A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 360(24):2503–2515
Farkouh ME, Domanski M, Sleeper LA et al (2012) Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 367(25):2375–2384
Bellemain-Appaix A, O’Connor SA, Silvain J et al (2012) Association of clopidogrel pretreatment with mortality, cardiovascular events, and major bleeding among patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. JAMA 308(23):2507–2516
Einhaltung ethischer Richtlinien
Interessenkonflikt. Den Interessenkonflikt der Autoren finden Sie online auf der DGK-Homepage unter http://leitlinien.dgk.org/ bei der entsprechenden Publikation.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sechtem, U., Achenbach, S., Gitt, A. et al. Kommentar zu den 2013 Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management der stabilen koronaren Herzkrankheit (KHK). Kardiologe 9, 159–164 (2015). https://doi.org/10.1007/s12181-015-0652-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12181-015-0652-x