Akutes Koronarsyndrom mit und ohne ST-Elevation

Zusammenfassung

Unter dem Oberbegriff des akuten Koronarsyndroms werden der ST-Hebungsinfarkt, der Nicht-ST-Hebungsinfarkt, die instabile Angina pectoris und der plötzliche Herztod zusammengefasst. Über 400 000 akute Koronarsyndrome pro Jahr allein in Deutschland belegen die Notwendigkeit differenzierter Diagnostik- und Behandlungspfade. Diese werden in den gängigen Leitlinien der kardiologischen Gesellschaften aufgeführt und erläutert. In der vorliegenden Arbeit wird anhand zweier Fallberichte aus der täglichen Routine die Umsetzung einer leitliniengetreuen Diagnostik und Therapie erläutert.

Abstract

Coronary artery disease accounts for most deaths in western communities. The acute coronary syndrome subsidizes ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina pectoris. They are characterized by an acute onset of chest pain.

The high number of acute coronary syndromes of more than 400,000 per year in Germany demonstrates the necessity of guidelines. Such guidelines are available from different cardiac societies. The implementation of the guidelines of the German Cardiac Society and the European Society of Cardiology in the daily clinical practice are demonstrated in this review by means of two case presentations. Special attention has been given to diagnostic measures, risk stratification, and different therapeutic options. For the diagnostic work-up in the acute phase, the ECG and the assessment of cardiac biomarkers play the central role. For patients with ST elevation myocardial infarction, primary interventional diagnostics and therapy are the first choice. For patients presenting with acute coronary syndromes without ST elevation, a risk-adapted therapeutic approach should be chosen. High-risk patients (elevated troponins, clinical, rhythmologic, and hemodynamic instability, ST depression, or diabetes mellitus) should be treated with an early invasive approach within 48–72 h. Low-risk patients can be treated primarily conservatively. For all patients who undergo interventional treatment, administration of an aggressive antiaggregatory therapy, including acetylsalicylic acid, clopidogrel, glycoprotein IIb/IIIa receptor antagonists, and heparin, is indicated in the acute phase. In the chronic phase, an adequate treatment of cardiovascular risk factors is of paramount importance.