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Chirurgische Myokardrevaskularisation bei infarktbedingtem kardiogenem Schock

Was wissen wir derzeit?

Surgical myocardial revascularization in cardiogenic shock complicating acute myocardial infarction

What do we currently know?

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Hintergrund

Der infarktbedingte kardiogene Schock ist ein lebensbedrohliches Krankheitsbild. Die derzeitige Standardtherapie ist die interventionelle Akutrevaskularisation des Infarktgefäßes. Die chirurgische Myokardrevaskularisation kommt nur selten zum Einsatz.

Ziel der Arbeit

Die Unterschiede zwischen interventioneller und chirurgischer Myokardrevaskularisation bei infarktbedingtem kardiogenem Schock sollen dargestellt werden. Weiterhin soll ein Überblick über die verfügbaren klinischen Daten zu chirurgischer Revaskularisation gegeben werden.

Material und Methoden

Analyse und Interpretation der verfügbaren Literatur mithilfe einer Recherche in MEDLINE, Erstellung eines narrativen Reviews.

Ergebnisse

Die interventionelle und chirurgische Revaskularisation unterscheiden sich in vielen relevanten Aspekten (u. a. Komplettheit der Revaskularisation, Reperfusionsmodalität, Zeit bis zur Reperfusion, lokale Verfügbarkeit). Zur interventionellen Revaskularisation existieren Daten aus prospektiven, randomisierten Studien, die Mortalitätsraten von 40–60 % zeigen. Zur chirurgischen Revaskularisation existieren retrospektive und Registerdaten, diese zeigen im Mittel Mortalitätsraten von 25–30 %.

Diskussion

Theoretische Aspekte des Therapiekonzepts und klinische Daten legen nahe, dass die chirurgische Revaskularisation bei Patienten mit infarktbedingtem kardiogenem Schock gegenüber der interventionellen Revaskularisation vorteilhaft sein könnte. Prospektive, randomisierte Daten hierzu sind erforderlich.

Abstract

Background

Cardiogenic shock complicating acute myocardial infarction is a life-threatening condition. The current therapeutic gold standard is immediate interventional revascularization of the culprit vessel. Surgical myocardial revascularization is seldomly applied.

Objective

The differences between interventional and surgical myocardial revascularization for cardiogenic shock complicating acute myocardial infarction are presented. Furthermore, an overview on the available clinical data concerning surgical revascularization is given.

Material and methods

Search, analysis and interpretation of the available literature in Medline. Composition of a narrative review.

Results

Interventional and surgical myocardial revascularization differ in many relevant aspects (e.g. completeness of revascularization, modality of reperfusion, time to reperfusion, local availability). Mortality rates after interventional revascularization (derived from prospective randomized trials) contemporarily range between 40% and 50%. For surgical revascularization, there exist only retrospective and register data. These show average mortality rates of 25–30%.

Discussion

Theoretical aspects of the treatment concept and clinical data suggest that surgical revascularization might be superior to interventional revascularization. Prospective, randomized data are needed.

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Abb. 1

Abbreviations

AMI:

Akuter Myokardinfarkt

CABG:

„Coronary artery bypass grafting surgery“ (aortokoronare Bypass-Operation)

CS-AMI:

„Cardiogenic shock complicating acute myocardial infarction“ (infarktbedingter kardiogener Schock)

ECLS:

„Extracorporeal life support“ (extrakorporale Kreislaufunterstützung)

ESC:

European Society of Cardiology

HZV:

Herz-Zeit-Volumen

IABP:

Intraaortale Ballonpumpe

IRI:

„Ischemia-reperfusion injury“ (Ischämie-Reperfusion-Schaden)

LCOS:

„Low-cardiac-output syndrome“ (Syndrom des reduzierten kardialen Auswurfs)

NSTEMI:

„Non-ST-segment elevation myocardial infarction“ (Nicht-ST-Strecken-Hebungsinfarkt)

PCI:

Perkutane Koronarintervention

SIRS:

Systemisch-inflammatorisches Response-Syndrom

STEMI:

„ST-segment elevation myocardial infarction“ (ST-Strecken-Hebungsinfarkt)

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Authors and Affiliations

  1. Sektion Kinderherzchirurgie, Klinik für Herzchirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland

    Philippe Grieshaber

  2. Klinik für Herz‑, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland

    Andreas Böning

Authors
  1. Philippe Grieshaber
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Correspondence to Philippe Grieshaber.

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Interessenkonflikt

P. Grieshaber und A. Böning geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Grieshaber, P., Böning, A. Chirurgische Myokardrevaskularisation bei infarktbedingtem kardiogenem Schock. Z Herz- Thorax- Gefäßchir 35, 277–282 (2021). https://doi.org/10.1007/s00398-021-00450-1

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  • DOI: https://doi.org/10.1007/s00398-021-00450-1

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