Der Internist

, Volume 47, Issue 12, pp 1251–1257

Therapie der stabilen koronaren Herzkrankheit

Wann Stent, wann medikamentös und wann Operation?
Schwerpunkt: Was ist gesichert in der Therapie?
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Zusammenfassung

Modifikation des Lebensstils und Behandlung der Risikofaktoren sind Grundlage der Therapie der koronaren Herzkrankheit. Zur medikamentösen Basistherapie mit prognostischer Wirksamkeit gehören Thrombozytenaggregationshemmer, Statine, Betablocker und in der Regel ACE-Hemmer. Symptomatisch wird Angina pectoris mit Nitraten, ggf. auch Kalziumantagonisten behandelt. Eine prognostische Indikation zur koronaren Revaskularisierung ergibt sich bei ausgedehnter Ischämie im Belastungstest oder Hochrisikobefund in der Koronarangiographie, insbesondere bei eingeschränkter Ventrikelfunktion. Eine symptomatische Indikation besteht bei Beschwerdepersistenz unter medikamentöser Therapie. Eingefäßerkrankung und unkomplizierte Zweigefäßerkrankung werden meist interventionell revaskularisiert (Stent). Hauptstammstenose, Dreigefäß- und schwere Zweigefäßerkrankung insbesondere bei eingeschränkter Ventrikelfunktion bleiben Domäne der Bypasschirurgie. Bei Patienten mit Mehrgefäßerkrankung, bei denen beide Verfahren möglich sind, ist in kontrollierten Studien der Langzeitverlauf hinsichtlich Prognose identisch, bei allerdings höherer Reinterventionsrate bei den Stentpatienten. Im Einzelfall fließen neben Koronarstatus und Ventrikelfunktion eine Reihe weiterer Patientenfaktoren in die Entscheidung über die Revaskularisierungsstrategie ein.

Schlüsselwörter

Koronare Herzkrankheit Arteriosklerose Koronarintervention Stent Bypassoperation 

Therapy of chronic coronary artery disease

Medical treatment vs. bypass surgery vs. coronary intervention

Abstract

The management of coronary artery disease should always include life style modification, control of cardiovascular risk factors and drugs with proven prognostic efficacy, i.e. antiplatelet drugs, statins, ß-blockers and, in most cases, ACE-inhibitors. Nitrates, sometimes also calcium antagonists, are used to control the symptoms of angina pectoris. Revascularisation by percutaneous treatment (stent implantation) or bypass surgery is indicated in patients with large areas of ischemia during stress testing or with high risk coronary anatomy during angiography, especially with reduced ventricular function, or when the angina cannot be adequately controlled by medicinal management. Single vessel and uncomplicated two vessel involvement are usually treated using a stent. Main stem stenosis, three vessel and severe two vessel involvement, particularly with reduced ventricular function, remain the domain of bypass surgery. Controlled studies show identical prognoses for patients with multiple vessel involvement for whom both treatment strategies are possible, although there is a higher reintervention rate for the stent patients. Coronary anatomy, ventricular function, as well as various patient-related factors have to be taken into account when deciding on the form of revascularisation therapy.

Keywords

Coronary artery disease Arteriosclerosis Coronary intervention Stent Bypass surgery 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.III. Medizinische KlinikKlinikum PassauPassauDeutschland

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