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Empfehlungen der Europäischen Gesellschaft für Kardiologie-Leitlinien 2017 – STEMI

Recommendations of the European Society of Cardiology Guideline 2017—STEMI

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Zusammenfassung

In diesem Beitrag werden die aktuellen Leitlinien der Europäischen Gesellschaft für Kardiologie aus dem Jahr 2017 zur Diagnostik und Therapie des akuten ST-Strecken-Hebungsinfarkts (STEMI) dargelegt und v. a. die Änderungen im Vergleich zu den früheren STEMI-Leitlinien von 2012 herausgearbeitet. Die primäre perkutane Koronarintervention (PCI) bleibt die bevorzugte Reperfusionstherapie. Veränderungen hinsichtlich der Revaskularisation betreffen besonders Empfehlungen zur Wahl des radialen Zugangswegs, zur Verwendung von Drug-Eluting-Stents anstelle von Bare-Metal-Stents sowie zur kompletten Revaskularisation und Vermeidung der Thrombusaspiration. Bei der Begleittherapie während der PCI wurde Bivalirudin herabgestuft. Die Indikation für eine O2-Therapie ist nur noch bei einer O2-Sättigung von <90 % gegeben. Die intraaortale Ballonpumpe sollte im kardiogenen Schock nicht mehr verwendet werden. Neue Empfehlungen gibt es auch in Bezug auf die Dauer der dualen Antiplättchentherapie für Patienten, bei denen nach den initialen 12 Monaten kein Blutungsereignis aufgetreten ist. Neue überarbeitete Abschnitte betreffen den Myokardinfarkt ohne relevante Koronarstenosen, die Einführung von Qualitätsindikatoren für Herzinfarktnetzwerke und neue Definitionen für die Zeiten bis zur Reperfusion.

Abstract

This article gives an update on the management of ST-segment elevation myocardial infarction (STEMI) according to the recently released 2017 European Society of Cardiology guidelines. Primary percutaneous coronary intervention remains the preferred reperfusion strategy. New guideline recommendations relate to the access site with clear preference of the radial artery, use of drug-eluting stents over bare-metal stents, complete revascularization during the index hospitalization, and avoidance of routine thrombus aspiration. For periprocedural anticoagulation, bivalirudin has been downgraded. Oxygen should be administered only if oxygen saturation is <90%. In cardiogenic shock, intra-aortic balloon pumping should not be used anymore. New recommendations are in place with respect to dual antiplatelet therapy duration for patients without a bleeding event during the first 12 months. Newly introduced chapters cover myocardial infarction with nonobstructed coronary arteries (MINOCA), new indicators for quality of care for STEMI networks, and new definitions for time to reperfusion.

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  1. Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig – Universitätsklinik, Strümpellstr. 39, 04289, Leipzig, Deutschland

    H. Thiele

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J. Hinkelbein, Köln

Dieser Beitrag basiert in Teilen auf Thiele H, Desch S, de Waha S (2017) Akuter Myokardinfarkt bei Patienten mit ST-Strecken-Hebungs-Infarkt. Herz https://doi.org/10.1007/s00059-017-4641-7.

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Thiele, H. Empfehlungen der Europäischen Gesellschaft für Kardiologie-Leitlinien 2017 – STEMI. Notfall Rettungsmed 21, 22–33 (2018). https://doi.org/10.1007/s10049-017-0402-7

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