Der Anaesthesist

, Volume 54, Issue 10, pp 957–974

Das akute Koronarsyndrom in der Prähospitalphase

Leitthema

Zusammenfassung

In der Bundesrepublik Deutschland verstarben im Jahr 2002 knapp 70.000 Menschen aufgrund eines akuten Myokardinfarkts (AMI), etwa 37% verstarben noch vor Erreichen der Klinik. Dies unterstreicht die besondere Relevanz einer adäquaten prähospitalen Versorgung. Anlass für die Einführung des gemeinsamen Oberbegriffes akutes Koronarsyndrom (ACS) ist der gemeinsame Pathomechanismus der verschiedenen ACS-Formen. Die Definition reicht von der instabilen Angina pectoris (iAP) über den Nicht-ST-Streckenhebungsinfarkt (NSTEMI) und den ST-Streckenhebungsinfarkt (STEMI) bis zum plötzlichen Herztod (PHT). Charakteristisch sind retrosternale Schmerzen, ggf. eine vegetative Symptomatik und Ausstrahlung des Schmerzes. Weiter differenziert wird das ACS nur durch das 12-Kanal EKG; herzspezifische Enzyme haben prähospital therapeutisch zurzeit keinen Stellenwert. Anamnese und Untersuchung sollten kurz und gezielt erfolgen, die Vitalparameter des Patienten engmaschig überwacht werden. Die Basistherapie besteht aus inhalativer Sauerstoffgabe, sublingualer Gabe von Glyceroltrinitrat, Morphin, Acetylsalicylsäure (ASS) und ggf. β-Blockern über einen peripher-venösen Zugang. Lässt sich die Diagnose STEMI durch 12-Kanal EKG und Anamnese eindeutig stellen, sollte bei allen Patienten ohne Kontraindikationen mit einer Fibrinolyse begonnen werden, sofern zu erwarten ist, dass die Verzögerung bis zu einer perkutanen koronaren (Katheter-)Intervention (PCI) >90 min und die Symptomdauer weniger als 12 h beträgt. Besonders günstig ist eine Symptomdauer <3 h. Patienten mit STEMI erhalten Heparin in Abhängigkeit von dem verwendeten Fibrinolytikum, eine Routinegabe von Heparin erhöht bei diesen Patienten die Blutungsrate, während Heparin bei Patienten mit iAP oder NSTEMI insgesamt das weitere Risiko senkt. Alle ACS-Patienten müssen vom Notarzt ins Krankenhaus begleitet werden. Patienten mit Komplikationen bzw. Kontraindikationen für eine Fibrinolyse sollten nach Möglichkeit in ein Zentrum mit akut verfügbarer Interventionsmöglichkeit (PCI) gebracht werden. Patienten mit unkompliziertem ACS können in jede Klinik mit einer geeigneten Intensivstation gebracht werden. Die Behandlung von Begleitkomplikationen richtet sich nach der Art und dem klinischem Schweregrad der Störung.

Schlüsselwörter

Akutes Koronarsyndrom Myokardinfarkt Instabile Angina pectoris Prähospitale Behandlung Thrombolyse 

Acute coronary syndrome in the prehospital phase

Abstract

Cardiovascular diseases are the number one cause of death in Germany. In 2002 about 70,000 people died of acute myocardial infarction (AMI) and of these 37% died before arrival at hospital which underlines the relevance of adequate prehospital care. The generic term acute coronary syndrome (ACS) was introduced because a single pathomechanism accounts for the different forms and comprises unstable angina pectoris (iAP), non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI) and sudden cardiac death (SCD). Characteristic features are retrosternal pain, vegetative symptoms and radiation of pain into the adjoining regions. Further differentiation can only be achieved by the 12-lead ECG, as cardiac-specific enzymes do not play a role in prehospital decisions. Prehospital delays should be avoided, history and physical examination should be brief but focused, vital parameters should be assessed and monitored. Basic treatment for ACS should comprise inhalative oxygen, nitrates, morphine, aspirin and β-blockers. If STEMI is diagnosed, patients with symptoms <12 h should undergo fibrinolytic therapy unless there is primary percutaneous coronary intervention (PCI) available within 90 min or if contraindicated. Heparin should be given to patients with STEMI depending on the choice of fibrinolytic agent, it otherwise results in a higher risk of bleeding, but in patients with iAP or NSTEMI it reduces mortality. All patients must be accompanied by the emergency physician during transportation and should be brought to a hospital with primary PCI, especially those with complicated ACS. Treatment of complications depends largely on the type, persistence and severity.

Keywords

Acute coronary syndrome Myocardial infarction Unstable angina pectoris Prehospital treatment Thrombolysis 

Literatur

  1. 1.
    Akkerhuis KM, Klootwijk PA, Lindeboom W, Umans VA, Meij S, Kint P, Simoons ML (2001) Recurrent ischaemia during continuous multilead St-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J 22:1997–2006CrossRefPubMedGoogle Scholar
  2. 2.
    Ambrosioni E, Borghi C, Magnani B (1995) The effect of the angiotensin-converting-enzyme inhibitor zofenopril on mortality and morbidity after anterior myocardial infarction: the Survival of Myocardial Infarction: Long-Term Evaluation (SMILE) Study Investigators. N Engl J Med 332:80–85CrossRefPubMedGoogle Scholar
  3. 3.
    Antman EM (2002) Early administration of intravenous magnesium to high-risk patients with acute myocardial infarction in the Magnesium in Coronaries (MAGIC) Trial: a randomised controlled trial. Lancet 360:1189–1196CrossRefPubMedGoogle Scholar
  4. 4.
    Antman EM, Berlin JA (1992) Declining incidence of ventricular fibrillation in myocardial infarction. Implications for the prophylactic use of lidocaine. Circulation 86:764–773PubMedGoogle Scholar
  5. 5.
    Antman EM, McCabe CH, Gurfinkel EP et al. (1999) Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI) 11B trial. Circulation 100:1593–1601PubMedGoogle Scholar
  6. 6.
    Antman EM, Cohen M, Radley D et al. (1999) Assessment of the treatment effect of enoxaparin for unstable angina/non-Q-wave myocardial infarction: TIMI 11B-ESSENCE metaanalysis. Circulation 100:1602–1608PubMedGoogle Scholar
  7. 7.
    Antman EM, Anbe DT, Armstrong PW et al. (2004) ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. Circulation 110:588–636CrossRefPubMedGoogle Scholar
  8. 8.
    Antiplatelet Trialists‘ Collaboration (1994) Collaborative overview of randomised trials of antiplatelet therapy, I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 308:81–106PubMedGoogle Scholar
  9. 9.
    Antithrombotic Trialists‘ Collaboration (2002) Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71–86CrossRefPubMedGoogle Scholar
  10. 10.
    Arntz HR, Stern R, Linderer T (1992) Efficiency of a physician-operated mobile intensive care unit for prehospital thrombolysis in acute myocardial infarction. Am J Cardiol 80:417–420CrossRefGoogle Scholar
  11. 11.
    Arntz HR, Tebbe U, Schuster HP, Sauer G, Meyer J (2000) Leitlinien zur Diagnostik und Therapie des akuten Herzinfarkts in der Prähospitalphase. Z Kardiol 89:364–370CrossRefGoogle Scholar
  12. 12.
    Aronow WS (1998) Use of beta-bockers during and after myocardial infarction. Comp Ther 24:327–331Google Scholar
  13. 13.
    ASSENT-2: Assessment of the Safety and Efficacy of a New Thrombolytic Investigators (1999) Singlebolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet 354:716–722CrossRefPubMedGoogle Scholar
  14. 14.
    Aufderheide TP, Kereiakes DJ, Weaver WD, Gibler WB, Simoons ML (1996) Planning, implementation and process monitoring for prehospital 12-lead ECG diagnostic programs. Prehospital Disaster Med 11:162–171PubMedGoogle Scholar
  15. 15.
    Bertrand ME, Simoons ML, Fox KAA et al. (2002) Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force on the Management of Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J 23:1809–1840CrossRefPubMedGoogle Scholar
  16. 16.
    Bippus PH, Storch WH, Andresen D, Schröder R (1987) Thrombolysis started at home in acute myocardial infarction: feasibility and time-gain. Circulation 76:122Google Scholar
  17. 17.
    Bode WE (1992) Non-Q-wave myocardial infarction: a prognostic paradox. Hosp Pract 27:79–92Google Scholar
  18. 18.
    Boersma E, Maas A, Deckers J, Simons M (1996) Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 348:771–775CrossRefPubMedGoogle Scholar
  19. 19.
    Bonnefoy E, Lapostolle F, Leizorovicz A et al. (2002) Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Comparison of Angioplasty and Prehospital Thrombolysis in Acute Myocardial Infarction (CAPTIM) Study Group. Lancet 360:825–829CrossRefPubMedGoogle Scholar
  20. 20.
    Böttiger BW, Grabner C, Bauer H, Bode C, Weber T, Motsch J, Martin E (1999) Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart 82:674–679PubMedGoogle Scholar
  21. 21.
    Böttiger BW, Bode C, Kern S et al. (2000) Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet 357:1583–1585Google Scholar
  22. 22.
    Braunwald E, Antman EM, Beasley JW et al. (2002) American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction — 2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). Circulation 106:1893–1900CrossRefPubMedGoogle Scholar
  23. 23.
    Brieger DB, Mak KH, Kottke-Marchant K, Topol EJ (1998) Heparin-induced thrombocytopenia. J Am Coll Cardiol 31:1449–1459CrossRefPubMedGoogle Scholar
  24. 24.
    Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R (1997) Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med 336:1276–1282PubMedGoogle Scholar
  25. 25.
    Cairns JA, Singer J, Gent M et al. (1989) One year mortality outcomes of all coronary and intensive care unit patients with acute myocardial infarction, unstable angina or other chest pain in Hamilton, Ontario, a city of 375,000 people. Can J Cardiol 5:239–246PubMedGoogle Scholar
  26. 26.
    Cannon CP, Gibson CM, McCabe CH et al. (1998) TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation 98:2805–2814PubMedGoogle Scholar
  27. 27.
    Canto JG, Every NR, Magid DJ et al. (2000) The volume of primary angioplasty procedures and survival after acute myocardial infarction. National Registry of Myocardial Infarction 2 Investigators. N Engl J Med 342:1573–1580CrossRefPubMedGoogle Scholar
  28. 28.
    CAPTURE Investigators (1997) Randomised placebo-controlled trial of abciximab before and during intervention in refractory unstable angina: the CAPTURE study. Lancet 349:1429–1435CrossRefPubMedGoogle Scholar
  29. 29.
    Casale PN, Jones JL, Wolf FE, Pei Y, Eby LM (1998) Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction. J Am Coll Cardiol 32:885–889CrossRefPubMedGoogle Scholar
  30. 30.
    Castaigne AD, Herve C, Duval-Moulin AM et al. (1989) Prehospital use of APSAC: results of a placebo-controlled study. Am J Cardiol 64:30A–33ACrossRefPubMedGoogle Scholar
  31. 31.
    CCS-1 (1995) Oral captopril versus placebo among 13,634 patients with suspected acute myocardial infarction: interim report from the Chinese Cardiac Study. Lancet 345:686–687PubMedGoogle Scholar
  32. 32.
    Chambless L, Keil U, Dobson A et al. (1997) Population versus clinical view of case fatality from acute coronary heart disease: results from the WHO MONICA Project 1985–1990. Multinational Monitoring of Trends and Determinants in Cardiovascular Disease. Circulation 96:3849–3859PubMedGoogle Scholar
  33. 33.
    Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman MA (1997) Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 79:1512–1516CrossRefPubMedGoogle Scholar
  34. 34.
    Cohen M, Demers C, Gurfinkel EP et al. (1997) A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med 337:447–452CrossRefPubMedGoogle Scholar
  35. 35.
    Colquhoun MC, Julien DG (1992) Sudden death in the community: the arrhythmia causing cardiac arrest and results of immediate resuscitation. Resuscitation 24:177ACrossRefGoogle Scholar
  36. 36.
    Dahlback B (2000) Blood coagulation. Lancet 355:1627–1632CrossRefPubMedGoogle Scholar
  37. 37.
    Dalby M, Bouzamondo A, Lechat P, Montalescot G (2003) Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation 108:1809–1814CrossRefPubMedGoogle Scholar
  38. 38.
    Davies MJ (2000) The pathophysiology of acute coronary syndromes. Heart 83:361–366CrossRefPubMedGoogle Scholar
  39. 39.
    Dracup K, Alonzo AA, Atkins JM et al. (1997) The physician’s role in minimizing prehospital delay in patients at high risk for acute myocardial infarction: recommendations from the National Heart Attack Alert Program. Working Group on Educational Strategies to Prevent Prehospital Delay in Patients at High Risk for Acute Myocardial Infarction. Ann Intern Med 126:645–651PubMedGoogle Scholar
  40. 40.
    Eikelboom JW, Anand SS, Malmberg K, Weitz JI, Ginsberg JS, Yusuf S (2000) Unfractionated heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a meta-analysis. Lancet 355:1936–1942CrossRefPubMedGoogle Scholar
  41. 41.
    El-Sherif N, Myerburg RJ, Scherlag BJ, Befeler B, Aranda JM, Castellanos A, Lazzara R (1976) Electrocardiographic antecedents of primary ventricular fibrillation: value of the R-on-T phenomenon in myocardial infarction. Br Heart J 38:415–422PubMedGoogle Scholar
  42. 42.
    European Myocardial Infarction Project Group (1993) (EMIP) Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. N Engl J Med 329:383–389CrossRefPubMedGoogle Scholar
  43. 43.
    Falk E (1985) Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation 71:699–708PubMedGoogle Scholar
  44. 44.
    Farb A, Tang AL, Burke AP, Sessums L, Liang Y, Virmani R (1995) Sudden coronary death: frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation 92:1701–1709PubMedGoogle Scholar
  45. 45.
    Fibrinolytic Trialists Collaborative Group (FTT) (1994) Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 343:311–322PubMedGoogle Scholar
  46. 46.
    Fresco C, Franzosi MG, Maggioni AP, Tognoni G (1990) The GISSI-2 trial: premises, results, epidemiological (and other) implications Gruppo Italiano per lo Studio delia Sopravvivenza nell’Infarto Miocardico. Clin Cardiol 13:32–36Google Scholar
  47. 47.
    FRISC study group (1996) Low-molecular-weight heparin during instability in coronary artery disease, Fragmin during Instability in Coronary Artery Disease (FRISC) study group. Lancet 347:561–568PubMedGoogle Scholar
  48. 48.
    Furberg CD, Psaty BM, Mayer JV (1995) Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation 92:1326–1331PubMedGoogle Scholar
  49. 49.
    Garber PJ, Gu S, Ducas J, Schick U, Prewitt RM (1995) An increase in low aortic pressure increases coronary artery flow and coronary thrombolysis induced by intravenous administration of recombinant tissue plasminogen activator. J Crit Care 10:1–6CrossRefPubMedGoogle Scholar
  50. 50.
    Gillum RF, Fortmann SP, Prineas RJ, Kottke TE (1984) International diagnostic criteria for acute myocardial infarction and acute stroke. Am Heart J 108:150–158CrossRefPubMedGoogle Scholar
  51. 51.
    GISSI-Avoidable Delay Study Group (1995) Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. A GISSI-generated study. Arch Intern Med 155:1481–1488Google Scholar
  52. 52.
    GISSI-3 (1994) Effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction: Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto Miocardico. Lancet 343:1115–1122PubMedGoogle Scholar
  53. 53.
    GREAT Group (1992) Feasibility, safety and efficacy of domiciliary thrombolysis by general practitioners: Grampian region early anistreplase trial. BMJ 305:548–553PubMedGoogle Scholar
  54. 54.
    Grijseels EW, Deckers JW, Hoes AW, Hartman JA, Does E van der, Loenen E van, Simoons ML (1995) Pre-hospital triage of patients with suspected myocardial infarction. Evaluation of previously developed algorithms and new proposals. Eur Heart J 16:325–332PubMedGoogle Scholar
  55. 55.
    Gust R, Gust A, Böttiger BW, Böhrer H, Martin E (1998) Bedside troponin T testing is not useful for early out-of-hospital diagnosis of myocardial infarction. Acta Anesthesiol Scand 42:414–417Google Scholar
  56. 56.
    GUSTO Investigators (1993) An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 329:673–682CrossRefPubMedGoogle Scholar
  57. 57.
    GUSTO III: The Global Use of Strategies to Open Occluded Coronary Arteries Investigators (1997) A comparsion of reteplase with alteplase for acute myocardial infarction. N Engl J Med 337:1118–1123CrossRefPubMedGoogle Scholar
  58. 58.
    Hamm CW, Bertrand M, Braunwald E (2001) Acute coronary syndrome without ST elevation: implementation of new guidelines. Lancet 358:1533–1538CrossRefPubMedGoogle Scholar
  59. 59.
    Hamm CW, Arntz HR, Bode C et al. (2004) Leitlinien. Akutes Koronarsyndrom. Teil 1: ACS ohne persistierende ST-Hebung. Z Kardiol 93:72–90CrossRefPubMedGoogle Scholar
  60. 60.
    Hamm CW, Arntz HR, Bode C et al. (2004) Leitlinien. Akutes Koronarsyndrom. Teil 2: ACS mit persistierender ST-Hebung. Z Kardiol 93:324–341CrossRefPubMedGoogle Scholar
  61. 61.
    Hochman JS, Sleeper LA, Webb JG et al. (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634CrossRefPubMedGoogle Scholar
  62. 62.
    Hochman JS, Sleeper LA, White HD et al. (2001) One-year survival following early revascularization for cardiogenic shock. JAMA 285:190–192CrossRefPubMedGoogle Scholar
  63. 63.
    Holmvang L, Andersen K, Dellborg AK et al. (1999) Relative contributions of a single-admission 12-lead electrocardiogram and early 24-hour continuous electrocardiographic monitoring for early risk stratification in patients with unstable coronary artery disease. Am J Cardiol 83:667–674CrossRefPubMedGoogle Scholar
  64. 64.
    ISIS-1 (1988) Mechanisms for the early mortality reduction produced by beta-blockade started early in acute myocardial infarction. ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Lancet 1:921–923PubMedGoogle Scholar
  65. 65.
    ISIS-2 (1988) Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 2:349–360PubMedGoogle Scholar
  66. 66.
    ISIS-3 (Third International Study on Infarct Survival) Collaborative Group (1992) A randomised comparison of streptokinase vs tissue plasminogen activator vs anistreptase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. Lancet 339:753–770PubMedGoogle Scholar
  67. 67.
    ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group (1994) ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet 345:669–685Google Scholar
  68. 68.
    Joint European Society of Cardiology/American College of Cardiology Commitee (2000) Myocardial infarction redefined — A consensus document of the Joint European Society of Cardiology/American College of Cardiology for the redefinition of myocardial infarction. Eur Heart J 21:1502–1513CrossRefPubMedGoogle Scholar
  69. 69.
    Joint International Society and Federation of Cardiology/World Health Organization Task Force on standardization of clinical nomenclature (1979) Nomenclature and criteria for diagnosis of ischemic heart disease. Circulation 59:607–609PubMedGoogle Scholar
  70. 70.
    Jugdutt BI, Warnica JW (1988) Intravenous nitroglycerin therapy to limit myocardial infarct size, expansion, and complications: effect of timing, dosage, and infarct location. Circulation 78:906–919PubMedGoogle Scholar
  71. 71.
    Juliard JM, Himbert D, Cristofini P et al. (1999) A matched comparison of the combination of rehospital thrombolysis and standby rescue angioplasty with primary angioplasty. Am J Cardiol 83:305–310CrossRefPubMedGoogle Scholar
  72. 72.
    Karagounis L, Ipsen SK, Jessop MR et al. (1990) Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. Am J Cardiol 66:786–791CrossRefPubMedGoogle Scholar
  73. 73.
    Kharb S, Singh V (2000) Magnesium deficiency potentiates free radical production associated with myocardial infarction. J Assoc Physicians India 48:484–485PubMedGoogle Scholar
  74. 74.
    Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20CrossRefPubMedGoogle Scholar
  75. 75.
    Kereiakes DJ, Gibler WB, Martin LH, Pieper KS, Anderson LC (1992) Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: a preliminary report from the Cincinnati Heart Project. Am Heart J 123:835–840CrossRefPubMedGoogle Scholar
  76. 76.
    Koenig W (1998) Epidemiology of coronary heart disease. Z Kardiol 87:3–7CrossRefPubMedGoogle Scholar
  77. 77.
    Kudenchuk PJ, Ho MT, Weaver WD et al. (1991) Accuracy of computer-interpreted electrocardiography in selecting patients for thrombolytic therapy. MITI Project Investigators. J Am Coll Cardiol 17:1486–1491PubMedGoogle Scholar
  78. 78.
    Larsson H, Areskog M, Areskog NH, Jonasson T, Ringqvist I, Fellenius C, Wallentin L (1995) The diagnostic and prognostic importance of ambulatory ST recording compared to a predischarge exercise test after an episode of unstable angina or non-Q wave myocardial infarction. Eur Heart J 16:888–893PubMedGoogle Scholar
  79. 79.
    Latini R, Maggioni AP, Flather M, Sleight P, Tognoni G (1995) ACE-inhibitor use in patients with myocardial infarction: summary of evidence from clinical trials. Circulation 92:3132–3137PubMedGoogle Scholar
  80. 80.
    Latorre F de, Nolan J, Robertson C, Chamberlain D, Baskett P (2001) European Resuscitation Council Guidelines 2000 for Adult Advanced Life Support. Resuscitation 48:211–221CrossRefPubMedGoogle Scholar
  81. 81.
    Lederer W, Lichtenberger C, Pechlaner C, Kroesen G, Baubin M (2001) Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out-of-hospital cardiac arrest. Resuscitation 50:71–76CrossRefPubMedGoogle Scholar
  82. 82.
    Leizorovicz A, Haugh MC, Mercier C, Boissel JP on behalf of the EMIP Group (1997) Pre-hospital and hospital. Lancet 343:311–322Google Scholar
  83. 83.
    Libby P (2001) Current concepts of the pathogenesis of the acute coronary syndromes. Circulation 104:365–372PubMedGoogle Scholar
  84. 84.
    Lie KI, Wellens HJ, Downar E, Durrer D (1975) Observations on patients with primary ventricular fibrillation complicating acute myocardial infarction. Circulation 52:755–759PubMedGoogle Scholar
  85. 85.
    Löwel H, Engel S, Hörmann A, Gostomzyk J, Bolte HD, Keil U für das MONICA-Augsburg Herzinfarktregisterteam (1999) Notfallmedizin: Akuter Herzinfarkt und plötzlicher Herztod aus epidemiologischer Sicht. Intensivmedizin 36:652–661CrossRefGoogle Scholar
  86. 86.
    Longstreth WT Jr, Litwin PE, Weaver WD (1993) Myocardial infarction, thrombolytic therapy, and stroke. A community-based study. The MITI Project Group. Stroke 24:587–590PubMedGoogle Scholar
  87. 87.
    Loubeyre C, Lefevre T, Louvard Y et al. (2001) Outcome after combined reperfusion therapy for acute myocardial infarction, combining pre-hospital thrombolysis with immediate percutaneous coronary intervention and stent. Eur Heart J 22:1128–1135CrossRefPubMedGoogle Scholar
  88. 88.
    Luiz T, Ellinger K, Budde A, Hechler C, Klar H, Riester T (1998) Evaluierung eines qualitativen Schnelltestes für kardiales Troponin T zur präklinischen Diagnostik bei Patienten mit akutem Koronarsyndrom. Z Kardiol 4:267–275CrossRefGoogle Scholar
  89. 89.
    Madias JE, Madias NE, Hood WB Jr (1976) Precordial ST-segment mapping, II: effects of oxygen inhalation on ischemic injury in patients with acute myocardial infarction. Circulation 53:411–417PubMedGoogle Scholar
  90. 90.
    Maroko PR, Radvany P, Braunwald E, Hale SL (1975) Reduction of infarct size by oxygen inhalation following acute coronary occlusion. Circulation 52:360–368PubMedGoogle Scholar
  91. 91.
    Matsusaka T, Hasebe N, Jin YT, Kawabe J, Kikuchi K (2002) Magnesium reduces myocardial infarct size via enhancement of adenosine mechanism in rabbits. Cardiovasc Res 54:568–575CrossRefPubMedGoogle Scholar
  92. 92.
    Merkhof LF van den, Zijlstra F, Olsson H et al. (1999) Abciximab in the treatment of acute myocardial infarction eligible for primary percutaneous transluminal coronary angioplasty. Results of the Glycoprotein Receptor Antagonist Patency Evaluation (GRAPE) Pilot Study. J Am Coll Cardiol 33:1528–1532CrossRefPubMedGoogle Scholar
  93. 93.
    MIAMI Trial Research Group (1985) Metoprolol in acute myocardial infarction: patient population. Am J Cardiol 56:1G–57GCrossRefGoogle Scholar
  94. 94.
    Montalescot G, Barragan P, Wittenberg O et al. (2001) Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 344:1895–1903CrossRefPubMedGoogle Scholar
  95. 95.
    Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ (2000) Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA 283:2686–2692CrossRefPubMedGoogle Scholar
  96. 96.
    Morrow DA, Antman EM, Sayah A et al. (2002) Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: results of The Early Retavase-Thrombolysis in Myocardial Infarction (ER-TIMI) 19 Trial. J Am Coll Cardiol 40:71–77CrossRefPubMedGoogle Scholar
  97. 97.
    Nallamothu B, Bates ER (2003) Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol 92:824–826CrossRefPubMedGoogle Scholar
  98. 98.
    National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee (1995) Staffing and equipping emergency medical services system: rapid identification and treatment of acute myocardial infarction. Am J Emerg Med 13:58–66PubMedGoogle Scholar
  99. 99.
    National Heart Attack Alert Program Coordinating Committee (1998) Access to timely and optimal care of patients with acute coronary syndromes — Community planning considerations: a report by the National Heart Attack Alert Program. J Thromb Thrombolysis 6:19–47CrossRefPubMedGoogle Scholar
  100. 100.
    Neuhaus KL, Feuerer W, Jeep-Tebbe S, Niederer W, Vogt A, Tebbe U (1989) Improved thrombolysis with a modified dose regimen of recombinant tissue-type plasminogen activator. J Am Coll Cardiol 14:1566–1569CrossRefPubMedGoogle Scholar
  101. 101.
    Newman DH, Greenwald I, Callaway CW (2000) Cardiac arrest and the role of thrombolytic agents. Ann Emerg Med 35:472–480PubMedGoogle Scholar
  102. 102.
    Norris RM (1998) Fatality outside hospital from acute coronary events in three British districts, 1994–5. United Kingdom Heart Attack Study Collaborative Group. BMJ 316:1065–1070PubMedGoogle Scholar
  103. 103.
    O’Doherty M, Taylor DI, Quinn E, Vincent R, Chamberlain DA (1983) Five hundred patients with myocardial infarction monitored within one hour of symptoms. BMJ 286:1405–1408PubMedGoogle Scholar
  104. 104.
    Oler A, Whooley MA, Oler J, Grady D (1996) Adding heparin to aspirin reduces the incidence of myocardial infarction and death in patients with unstable angina. A meta-analysis. JAMA 276:811–815CrossRefPubMedGoogle Scholar
  105. 105.
    Pantridge JF, Geddes JS (1967) A mobile intensive-care unit in the management of myocardial infarction. Lancet 2:271–273CrossRefPubMedGoogle Scholar
  106. 106.
    PARAGON Investigators (1998) International, randomized, controlled trial of lamifiban (a platelet glycoprotein IIb/IIIa inhibitor), heparin, or both in unstable angina. Circulation 97:2386–2395PubMedGoogle Scholar
  107. 107.
    Patel DJ, Holdright DR, Knight CJ et al. (1996) Early continuous ST segment monitoring in unstable angina: prognostic value additional to the clinical characteristics and the admission electrocardiogram. Heart 75:222–228PubMedGoogle Scholar
  108. 108.
    Popma JJ, Califf RM, Ellis SG et al. (1992) Mechanism of benefit of combination thrombolytic therapy for acute myocardial infarction: a quantitative angiographic and hematologic study. J Am Coll Cardiol 20:1305–1312PubMedGoogle Scholar
  109. 109.
    Popovic AD, Neskovic AN, Babic R et al. (1994) Independent impact of thrombolytic therapy and vessel patency on left ventricular dilation after myocardial infarction. Serial echocardiographic follow-up. Circulation 90:800–807PubMedGoogle Scholar
  110. 110.
    PRISM Investigators (1998) A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. N Engl J Med 338:1498–1505CrossRefPubMedGoogle Scholar
  111. 111.
    PRISM-PLUS Investigators (1998) Inhibition of the platelet glycoprotein IIb/IIIa with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med 338:1488–1497CrossRefPubMedGoogle Scholar
  112. 112.
    PURSUIT Investigators (1998) Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy. N Engl J Med 339:436–443CrossRefPubMedGoogle Scholar
  113. 113.
    Rao AK, Pratt C, Berke A et al. (1988) Thrombolysis in Myocardial Infarction (TIMI) Trial-phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 11:1–11PubMedGoogle Scholar
  114. 114.
    Rat der Europäischen Gemeinschaften (1991) Entscheidung des Rates vom 29. Juli 1991 zur Einführung einer einheitlichen europäischen Notrufnummer (91/396/EWG). Amtsblatt der Europäischen Gemeinschaften L 217/31 (6–8-91)Google Scholar
  115. 115.
    Rawles J (1994) Halving of mortality at 1 year by domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial (GREAT). J Am Coll Cardiol 23:1–5PubMedGoogle Scholar
  116. 116.
    Rawles J (2003) GREAT: 10 year survival of patients with suspected acute myocardial infarction in a randomised comparison of prehospital and hospital thrombolysis. Heart 89:563–564CrossRefPubMedGoogle Scholar
  117. 117.
    Reimer KA, Lowe JE, Rasmussen MM, Jennings RB (1977) The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 56:786–794PubMedGoogle Scholar
  118. 118.
    RISC Group (1990) Risc of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 336:827–830CrossRefPubMedGoogle Scholar
  119. 119.
    Robertson C, Stehen P, Adgey J et al. (1998) The 1998 European Resuscitation Council guidelines for adult advanced life support. Resuscitation 37:81–90CrossRefPubMedGoogle Scholar
  120. 120.
    Rosenberg RD, Aird WC (1999) Vascular-bed: specific hemostasis and hypercoagulable states. N Engl J Med 340:1555–1564CrossRefPubMedGoogle Scholar
  121. 121.
    Ross AM, Coyne KS, Reiner JS et al. (1999) A randomized trial comparing primary angioplasty with a strategy of short acting thrombolysis and immediate planned rescue angiolasty in acute myocardial infarction: the PACT trial. PACT investigators. Plasminogen-activator Angioplasty Compatibility Trial. J Am Coll Cardiol 34:1954–1962CrossRefPubMedGoogle Scholar
  122. 122.
    Sabatine MS, McCabe CH, Gibson CM, Cannon CP (2005) Design and rationale of Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction (CLARITY-TIMI) 28 trial. Am Heart J 149:227–233CrossRefPubMedGoogle Scholar
  123. 123.
    Savonitto S, Ardissino D, Granger CB et al. (1999) Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA 281:707–713CrossRefPubMedGoogle Scholar
  124. 124.
    Shechter M, Hod H, Chouraqui P, Kaplinsky E, Rabinowitz B (1995) Magnesium therapy in acute myocardial infarction when patients are not candidates for thrombolytic therapy. Am J Cardiol 75:321–323CrossRefPubMedGoogle Scholar
  125. 125.
    Schofer J, Buttner J, Geng G et al. (1990) Prehospital thrombolysis in acute myocardial infarction. Am J Cardiol 66:1429–1433CrossRefPubMedGoogle Scholar
  126. 126.
    Scholz KH, Tebbe U, Hermann G, Woijcik J, Lingen JM, Chemnitius JM (1992) Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol 69:724–728CrossRefPubMedGoogle Scholar
  127. 127.
    Schuchert A, Hamm C, Scholz J, Klimmeck S, Goldmann B, Meinertz T (1999) Prehospital testing for troponin T in patients with suspected acute myocardial infarction. Am Heart J 138:45–48PubMedGoogle Scholar
  128. 128.
    Simoons ML, Maggioni AP, Knatterud G et al. (1993) Individual risk assessment for intracranial haemorrhage during thrombolytic therapy. Lancet 342:1523–1528CrossRefPubMedGoogle Scholar
  129. 129.
    Sigurdsson A, Swedberg K (1994) Left ventricular remodelling, neurohormonal activation and early treatment with enalapril (CONSENSUS II) following myocardial infarction. Eur Heart J 15:14–19Google Scholar
  130. 130.
    Silfvast T (1991) Cause of death in unsuccessful prehospital resuscitation. J Intern Med 229:331–335PubMedGoogle Scholar
  131. 131.
    Spaulding CM, Joly LM, Rosenberg A, Monchi M, Weber SN, Dhainaut JF, Carli P (1997) Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med 336:1629–1633CrossRefPubMedGoogle Scholar
  132. 132.
    Steg PG, Bonnefoy E, Chaubaud S et al. (2003) Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty. Circulation 108:2851–2856CrossRefPubMedGoogle Scholar
  133. 133.
    Statistisches Bundesamt (2002) Gesundheitswesen: Todesursachen in Deutschland. Fachserie 12/ Reihe 4Google Scholar
  134. 134.
    Task Force Report (1998) The pre-hospital management of acute heart attacks. Eur Heart J 19:1140–1164CrossRefPubMedGoogle Scholar
  135. 135.
    Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology (1996) Acute myocardial infarction: pre-hospital and in-hospital management. Eur Heart J 17:43–63Google Scholar
  136. 136.
    Theroux P, Waters D, Qiu S, McCans J, Guise P de, Juneau M (1993) Aspirin versus heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation 88:2045–2048PubMedGoogle Scholar
  137. 137.
    TIMI Study Group (1989) Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the thrombolysis in myocardial infarction (TIMI) phase II trial. N Engl J Med 320:618–627PubMedGoogle Scholar
  138. 138.
    Thiemann DR, Coresh J, Schulman SP, Gerstenblith G, Oetjen WJ, Powe NR (2000) Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 101:2239PubMedGoogle Scholar
  139. 139.
    Tiefenbrunn AJ, Chandra NC, French WJ et al. (1998) Clinical experience with primary percutaneous transluminal coronary angioplasty compared with alteplase (recombinant tissue-type plasminogen activator) in patients with acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol 31:1240–1245CrossRefPubMedGoogle Scholar
  140. 140.
    Trappe HJ, Brugada P, Lezaun R, Wellens HJ (1989) The significance of ventricular tachycardia morphology for prognosis and follow-up. Z Kardiol 78:633–639PubMedGoogle Scholar
  141. 141.
    Tunstall-Pedoe H, Kuulasmaa K, Mahonen M et al. (1999) Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 353:1547–1557CrossRefPubMedGoogle Scholar
  142. 142.
    Urban P, Stauffer JC, Bleed D et al. (1999) A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH. Eur Heart J 20:1030–1038CrossRefPubMedGoogle Scholar
  143. 143.
    Virmani R, Burke AP, Farb A (1998) Plaque morphology in sudden coronary death. Cardiologia 43:267–271PubMedGoogle Scholar
  144. 144.
    Wallentin L, Goldstein P, Armstrong PW et al. (2003) Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting (ASSENT 3 Plus). Circulation 108:135–142CrossRefPubMedGoogle Scholar
  145. 145.
    Weaver WD (1995) Time to thrombolytic treatment: factors affecting delay and their influence on outcome. J Am Coll Cardiol 25:3S–9SCrossRefPubMedGoogle Scholar
  146. 146.
    Weaver WD, Cerqueira M, Hallstrom AP, Litwin PE, Martin JS, Kudenchuk PJ, Eisenberg M (1993) Prehospital-initiated vs hospital-initiated thrombolytic therapy. The Myocardial Infarction Triage and Intervention Trial. JAMA 270:1211–1216CrossRefPubMedGoogle Scholar
  147. 147.
    Werf F van de, Ardissino D, Betriu A et al. (2003) Management of acute myocardial infarction in patients presenting with ST-segment elevation. Task Force of the ESC. Eur Heart J 24:28–66PubMedGoogle Scholar
  148. 148.
    White HD (2000) Thrombolytic therapy in the elderly. Lancet 356:228–230CrossRefPubMedGoogle Scholar
  149. 149.
    Widimsky P, Budesinsky T, Vorac D et al. „PRAGUE“ Study Group Investigators (2003) Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial — PRAGUE-2. Eur Heart J 24:94–104CrossRefPubMedGoogle Scholar
  150. 150.
    Woods KL, Fletcher S, Roffe C, Haider Y (1992) Intravenous magnesium sulphate in suspected acute myocardial infarction: results of the second Leicester Intravenous Magnesium Intervention Trial (LIMIT-2). Lancet 339:1553–1558CrossRefPubMedGoogle Scholar
  151. 151.
    Yusuf S, Peto R, Lewis J, Collins R, Sleight P (1985) Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 27:335–371PubMedGoogle Scholar
  152. 152.
    Yusuf S, MacMahon S, Collins R, Peto R (1988) Effect of intravenous nitrates on mortality in acute myocardial infarction: an overview of the randomised trials. Lancet 1:1088–1092CrossRefPubMedGoogle Scholar
  153. 153.
    Yusuf S, Held P, Furberg C (1991) Update of effects of calcium antagonists in myocardial infarction or angina in light of the second Danish Verapamil Infarction Trial (DAVIT-II) and other recent studies. Am J Cardiol 67:1295–1297CrossRefPubMedGoogle Scholar
  154. 154.
    Yusuf S, Lessem J, Jha O et al. (1993) Primary and secondary prevention of myocardial infarction and strokes: an update of randomly allocated controlled trials. J Hypertens Suppl 11:61–73Google Scholar
  155. 155.
    Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 345:494–502Google Scholar
  156. 156.
    Zijlstra F, Hoorntje JC, Boer MJ de et al. (1999) Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 341:1413–1419CrossRefPubMedGoogle Scholar
  157. 157.
    Zipes DP, Wellens HJ (1998) Sudden cardiac death. Circulation 98:2334–2351PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Klinik für AnaesthesiologieUniversitätsklinikumHeidelberg
  2. 2.Medizinische Klinik II Kardiologie und PulmologieCharite, Campus Benjamin FranklinBerlin
  3. 3.Klinik für AnaesthesiologieUniversitätsklinikumHeidelberg

Personalised recommendations