Zusammenfassung
Die koronare Herzkrankheit gilt als die häufigste Todesursache in den westlichen Ländern. Dabei spielen nicht nur genetische, sondern auch Umwelteinflüsse eine wichtige Rolle. In Deutschland erleiden jedes Jahr pro 100.000 Einwohnern 444 Männer und 138 Frauen einen Myokardinfarkt. 50% dieser Patienten versterben an dem Infarkt, 30%, bevor ihnen ärztliche Hilfe zuteil werden kann.
Der Begriff der koronaren Herzerkrankung kann unterteilt werden in stabile Formen der Koronarerkrankung, z.B. die stabile Angina pectoris, und in ein sog. akutes Koronarsyndrom. Letzteres schliisst nicht nur Formen der instabilen Angina ein, sondern auch den akuten Myokardinfarkt, vorausgesetzt eine Myokardschädigung liegt vor. Die Behandlung der koronaren Herzerkrankung besteht nicht nur in der Akuttherapie, sondern insbesondere in der Primär- und Sekundärprävention. Dabei hat sich gezeigt, dass durch eine konsequente Behandlung von Risikofaktoren wie Hypertonie, Nikotinabusus oder Hypercholesterinämie eine signifikante Risikoreduktion für schwerwiegende kardiale Ereignisse erreicht werden kann.
Neben Statinen, ACE Hemmern und auch Betarezeptorenblockern ist aber Acetylsalicylsäure (ASS) immer noch mit das wichtigste Medikament bei der Behandlung der koronaren Herzerkrankung. Beim akuten Koronarsyndrom ist sie das erste Medikament, das neben Heparin zum Einsatz kommt. Ansonsten hat sich die Akutbehandlung des Myokardinfarktes in den letzten 20 Jahren mit dem Einsatz der Lysetherapie und interventioneller Verfahren zur koronaren Revaskularisierung entscheidend verbessert. Spätestens seit der groß angelegten GUSTO-I-Studie (Global Utilization of Streptokinase for Occluded Arteries Study) von 1993 ist die Thrombolysetherapie bei der Behandlung des akuten Myokardinfarktes wichtigste konservative Behandlungsalternative zur akuten Revaskularisation (The GUSTO Investigators 1993). Die PTCA ist nach heutigem Standard aber die effektivste Behandlungsmodalität zur Akutbehandlung des Myokardinfarktes, noch vor der Thrombolysetherapie, was durch eine Reihe von Vergleichsstudien in den letzten Jahren belegt wurde.
Durch adjunktive Therapie mittels einer neuen Generation von Thrombozyten-aggregationshemmern, den GP-IIb/IIIa-Antagonisten wie Abciximab, Tirofiban oder Eptifibatid, hat sich ein weiteres wichtiges Kapitel bei der Behandlung des akuten Koronarsyndroms aufgetan. Neue aufregende Therapieformen eröffnen sich unter dem Begriff Angiogenese (Gefäßneubildung). So verspricht die Stammzellentherapie oder die Therapie mit Genprodukten zur Induktion einer intrakardialen Gefäßneubildung neue Dimensionen bei der Therapie der stabilen koronaren Herzerkrankung, aber auch beim akuten Koronarsyndrom.
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Spyridopoulos, I., Zeiher, A. (2005). Koronarinsuffizienz und Herzinfarkt. In: Steinbeck, G., et al. Therapie innerer Krankheiten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-26504-X_1
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