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Aktuelle Aspekte der β-Blocker-Therapie zur Sekundärprävention und Kardioprotektion bei Gefäßpatienten

Current aspects of beta blocker treatment for secondary prevention and cardioprotection in vascular surgery patients

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Zusammenfassung

Auf dem Boden der Atherothrombose sind Patienten mit peripherer arterieller Verschlusskrankheit (PAVK) in der Mehrheit polylokal erkrankt und haben daher ein besonders hohes kardiovaskuläres Risiko, insbesondere perioperativ. Beiden, der medikamentösen Sekundärprävention und der perioperativen Kardioprotektion, kommt hinsichtlich kardiovaskulärer Ereignisse eine hohe prognostische Bedeutung. Myokardinfarkt und kardialer Tod sind die Hauptursachen der perioperativen Mortalität von Gefäßpatienten. Der Einsatz der sekundärpräventiven und perioperativen Gabe von β‑Blockern zur kardiovaskulären Risikoreduktion bei Patienten mit PAVK ist seit Langem in kontroverser Diskussion. Empfehlungen der Leitlinien sind teilweise widersprüchlich und validierte Behandlungspfade fehlen weitgehend. Anhand der aktuellen Literatur und der gültigen europäischen und amerikanischen Leitlinien werden die derzeitige Evidenz zum Einsatz der β‑Blocker-Therapie sowohl sekundärprophylaktisch als auch perioperativ beleuchtet und Empfehlungen formuliert.

Abstract

Due to the underlying atherothrombosis, the majority of patients with peripheral arterial occlusive disease (PAOD) have multiple localizations of disease and therefore have a particularly high cardiovascular risk, especially in the perioperative period. Both medicinal secondary prevention and perioperative cardioprotection are of high prognostic importance with respect to cardiovascular events. Myocardial infarction and cardiovascular death are the most common causes for perioperative mortality in vascular surgery patients. The use of secondary preventive and perioperative beta-blockers for reduction of the cardiovascular risk in patients with PAOD has long been a matter of controversial discussion. Recommendations in guidelines are partially contradictory and clinically validated treatment pathways are still lacking. Based on the currently available literature and the valid European and American guidelines, the current evidence on the secondary prophylactic and perioperative use of beta-blocker treatment is illustrated and recommendations are formulated.

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  1. Klinik für Gefäßchirurgie und Angiologie, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131, Essen, Deutschland

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Nowak, T., Jacke, C. Aktuelle Aspekte der β-Blocker-Therapie zur Sekundärprävention und Kardioprotektion bei Gefäßpatienten. Gefässchirurgie 25, 179–186 (2020). https://doi.org/10.1007/s00772-020-00632-5

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