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Myokardrevaskularisation

Myocardial revascularization

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Zusammenfassung

Die koronare Herzkrankheit (KHK) zählt zu den häufigsten Erkrankungen der westlichen Welt und ist aufgrund der weiter steigenden Prävalenz von zentraler sozioökonomischer Bedeutung. Bis zur Einführung der perkutanen Koronarintervention (PCI) konnte die KHK neben der medikamentösen Therapie nur operativ behandelt werden. Die In-Stent-Restenose ist ein zentrales Problem nach Stentimplantation; durch die Verwendung neuer Stentmaterialien und -beschichtungen konnte die Häufigkeit dieser Komplikation jedoch entscheidend gesenkt werden. Heutzutage stehen daher mit der operativen Myokardrevaskularisation und der PCI 2 gleichwertige Therapieverfahren zur Verfügung. Welches Therapieverfahren für den Patienten geeignet ist, hängt u. a. von der Anzahl der erkrankten Gefäße, der Komplexität der Stenosen, von Begleiterkrankungen und dem Allgemeinzustand des Patienten ab. Das Behandlungsregime sollte anhand der Leitlinien der Europäischen und der Deutschen Gesellschaft für Kardiologie ausgerichtet werden, bei komplexen oder grenzwertigen Befunden empfiehlt sich die Besprechung des individuellen Therapiekonzepts in einer interdisziplinären Fallkonferenz.

Abstract

Coronary artery disease (CAD) is a leading cause of morbidity and mortality in western countries and is of significant socio-economic importance due to its increasing prevalence. Until percutaneous coronary interventions (PCI) were established, CAD could only be treated by surgical revascularization or pharmacological therapy. In-stent restenosis remains a major problem after stent implantation. However, the use of new materials and stent coatings have led to a significant reduction in in-stent restenosis. Thus, surgical revascularization and PCI are currently of equal value for the treatment of CAD. The decision-making for PCI or surgical revascularization depends on various factors such as number of diseased vessels, complexity of the coronary stenoses, concomitant diseases, and the patient’s general condition. The therapeutic regime of every patient should be adjusted to the recommendations of the European and German Society for Cardiology, while controversial and complex cases should be discussed in an interdisciplinary case conference (“heart team”).

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: Möllmann: Abbott, Boston Scientific, Medtronic, Translumina, Daichii Sankyo, Lilly, AstraZeneca, Boehringer Ingelheim, Berlin-Chemie. Kempfert, Walther, Szardien: keine. Nef: Boston Scientific, Medtronic, Translumina, Terumo, Novartis, Daichii Sankyo, Lilly, AstraZeneca, Boehringer Ingelheim, Berlin-Chemie. Hamm: Medtronic, Boston Scientific, Abbott.

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Authors and Affiliations

  1. Abteilung für Kardiologie, Kerckhoff-Klinik Bad Nauheim, Benekestr. 2–8, 61231, Bad Nauheim, Deutschland

    H. Möllmann, S. Szardien, H. Nef, C. Liebetrau & C. Hamm

  2. Abteilung für Herzchirurgie, Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, Deutschland

    J. Kempfert & T. Walther

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  1. H. Möllmann
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  2. S. Szardien
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  3. J. Kempfert
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  4. H. Nef
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  5. C. Liebetrau
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  6. T. Walther
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  7. C. Hamm
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Correspondence to H. Möllmann.

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Übernahmehinweis

Dieser aktualisierte Beitrag erschien ursprünglich in der Zeitschrift Der Internist 2012, 53:1063–1078, doi 10.1007/s00108-012-3035-4. Die Teilnahme an der zertifizierten Fortbildung ist nur einmal möglich.

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Möllmann, H., Szardien, S., Kempfert, J. et al. Myokardrevaskularisation. Herz 38, 513–528 (2013). https://doi.org/10.1007/s00059-013-3917-9

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