Der Internist

, Volume 47, Issue 7, pp 699–706

Behandlungspfad „Akutes Koronarsyndrom“

Schwerpunkt: Behandlungspfade

Zusammenfassung

Der Behandlungspfad „Akutes Koronarsyndrom“ des Marburger Universitätsklinikums beschreibt das Vorgehen bei Patienten mit ST-Streckenhebungsinfarkt (STEMI), Nicht-ST-Streckenhebungsinfarkt (NSTEMI) und Troponin negativer instabiler Angina pectoris (AP) an einem Klinikum mit Herzkatheterlabor und 24-h-PTCA-Bereitschaft. Bei allen Patienten mit akutem Koronarsyndrom wird innerhalb von 10 min ein 12-Kanal-EKG angefertigt und beurteilt. Alle Patienten mit STEMI werden bei Schmerzbeginn <12 h umgehend nach Gabe der Basismedikation einer Revaskularisation mittels primärer perkutaner Katheterintervention (PCI) zugeführt. Eine primäre PCI erfolgt ebenfalls bei allen Patienten mit NSTEMI, persistierender AP, Rhythmus- oder Blutdruckinstabilität. Patienten mit instabiler AP, die nach Applikation der Basismedikation zwar beschwerdefrei sind, aber zusätzliche Risikofaktoren aufweisen, werden innerhalb von 48 h koronarangiographiert. Bei Patienten mit 2fach negativem kardialem Troponin im Abstand von 6–12 h ist ein akuter Myokardinfarkt ausgeschlossen. Bei diesen Patienten erfolgt eine weitere differenzialdiagnostische Abklärung möglicher kardialer und extrakardialer Ursachen. Die verbindliche und von allen Beteiligten konsentierte Einführung des leitlinienkonformen Behandlungspfads vor 2 Jahren hat klinikinterne Entscheidungsalgorithmen im Zentrum für Innere Medizin und auf den Intensivstationen des gesamten Klinikums verbindlich strukturiert und die Abläufe deutlich verbessert.

Schlüsselwörter

Akutes Koronarsyndrom Myokardinfarkt Revaskularisation Behandlungspfad 

Clinical pathway “Acute Coronary Syndrome”

Abstract

The clinical pathway “acute coronary syndrome” of the university hospital Marburg describes the guideline-conform and consented management of patients with ST-segment elevation infarct (STEMI), non-ST-segment elevation infarct (NSTEMI) and Troponin negative unstable angina. A 12-lead ECG recording is made and read in all patients within 10 minutes. All patients with STEMI undergo immediate revascularisation using primary percutanuous catheter intervention (PCI) after administration of basic medical therapy. Primary PCI is also used in all patients with NSTEMI, persistent chest pain, rhythm or hemodynamic instability. Patients with unstable angina, who became free of symptoms after application of basic medication, but who have additional risk factors undergo cardiac catheterisation within 48 hours. Acute myocardial infarction can be ruled out in patients with twofold negative cardiac troponin levels during 6–12 hours. In the absence of further symptoms, these patiens undergo differential diagnostic evaluation of cardiac and extracardiac causes of chest pain. The introduction of this clinical pathway 2 years ago, which was consented before by the hospital board and the clinical directors, has lead to a remarkable improvement in the clinical decision-making at the emergency room of the hospital and reduced the door to intervention time considerably.

Keywords

Acute coronary syndrome Clinical pathway Myocardial infarction Revascularisation 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Zentrum für Innere MedizinPhilipps-Universität Marburg
  2. 2.Klinik für Innere MedizinUniversitätsklinikumMarburg

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