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Kommentar zu den 2015‑Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des akuten Koronarsyndroms ohne ST‑Hebungen (NSTE-ACS)

Comments on the 2015 guidelines of the European Society of Cardiology (ESC) for management of non-ST elevation acute coronary syndrome (NSTE-ACS)

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Der Kardiologe Aims and scope

Zusammenfassung

Die neue NSTE-ACS (akutes Koronarsyndrom ohne ST-Hebungen)-Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) inkorporiert wichtige aktuelle Erkenntnisse insbesondere hinsichtlich der Früherkennung des NSTE-ACS und erleichtert über einen 0‑h/1-h-Algorithmus die Triage in den „chest pain units“. Bezüglich der Dauer der antithrombotischen Therapie nach perkutaner Koronarintervention bei NSTE-ACS bleiben 12 Monate der Standard, kürzere wie auch längere Therapiephasen sind jedoch entsprechend aktueller Studienergebnisse nach individueller Risiko-Nutzen-Abwägung in Ausnahmefällen möglich. Bei ACS-Patienten mit zusätzlicher Indikation zur oralen Antikoagulation wird weiterhin eine Triple-Therapie empfohlen, deren Dauer sich nach dem individuellen Blutungs- und Ischämierisiko richten muss. Bei Patienten mit nichtvalvulärem Vorhofflimmern sind aufgrund ihres günstigeren Risikoprofils hinsichtlich Blutung nun auch neue orale Antikoagulanzien (NOAKs) als Alternative zu Vitamin-K-Antagonisten (VKA) in den Leitlinien verankert. Randomisierte Studien prüfen derzeit den Stellenwert von NOAKs, aber auch dualer Behandlungskonzepte (orale Antikoagulation plus antithrombozytäre Monotherapie) in der akuten und chronischen Phase.

Abstract

The new European Society of Cardiology (ESC) guidelines on non-ST elevation acute coronary syndrome (NSTE-ACS) reflect important current scientific evidence regarding early diagnosis of NSTE-ACS and facilitate better patient triage in chest pain units using a 0 h/1 h rule in/rule out algorithm. Furthermore, 12 months remain the standard duration of antithrombotic therapy after percutaneous coronary intervention (PCI) for NSTE-ACS, while based on current evidence shorter or longer treatment duration is possible in exceptional cases after careful consideration of the individual patient risks and benefits. For ACS patients with additional indications for oral anticoagulation, triple therapy is still recommended and the duration strongly depends on individual risks of bleeding and ischemia. In addition, due to a favorable safety profile, non-vitamin K oral anticoagulants (NOAC) might be considered in patients with non-valvular atrial fibrillation as an alternative to vitamin K antagonists (VKA). There are several randomized trials currently investigating both NOAC and different dual antithrombotic treatment strategies (e.g. OAC plus antiplatelet monotherapy) in the acute and chronic phases of ACS.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

    J. Mehilli & S. Massberg

  2. Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK, Berlin, Deutschland

    J. Mehilli, U. Landmesser & S. Massberg

  3. Medizinische Klinik I – Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland

    C. W. Hamm

  4. Medizinische Klinik für Kardiologie und Pulmologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    U. Landmesser

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  1. J. Mehilli
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Correspondence to J. Mehilli.

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Mehilli, J., Hamm, C.W., Landmesser, U. et al. Kommentar zu den 2015‑Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des akuten Koronarsyndroms ohne ST‑Hebungen (NSTE-ACS). Kardiologe 10, 351–358 (2016). https://doi.org/10.1007/s12181-016-0094-0

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