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Chronische koronare Herzkrankheit

Behandlungsstrategien zur Revaskularisation

Chronic coronary heart disease

Treatment strategies for revascularization

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Der Kardiologe Aims and scope

Zusammenfassung

Die chronische koronare Herzkrankheit mit dem Hauptsymptom der stabilen Angina Pectoris ist eine der häufigsten Erkrankungen der Industrienationen. Ziel der Behandlung der chronischen koronaren Herzerkrankung ist primär eine Verbesserung der Prognose, jedoch ist die Steigerung der krankheitsbedingt eingeschränkten Lebensqualität bei gleichzeitig niedriger Komplikationsrate der Therapiemaßnahme für den Patienten ebenfalls von entscheidender Bedeutung. Als Behandlungsoptionen stehen neben Lebensstiländerungen und der medikamentösen Therapie seit Ende der 60er-Jahre auch die aortokoronare Bypassoperation sowie seit 1977 die perkutane transluminale Koronarangioplastie bzw. perkutane Koronarintervention zur Verfügung. Sowohl die operativen als auch die interventionellen Revaskularisationsverfahren sind seitdem kontinuierlich weiterentwickelt und verbessert worden. Parallel dazu sind auch bei der medikamentösen Therapie große Fortschritte erzielt worden, sodass diese 3 Therapieoptionen je nach Befundkonstellation um das beste Behandlungskonzept wetteifern.

Abstract

Chronic coronary heart disease, with the major symptom of stable angina pectoris, is one of the most common diseases in industrialized countries. The aim of treatment is primarily to improve the prognosis, however, an increase in disease reduced quality of life with a simultaneous lowering of complications is also of great importance for the patient. In addition to medication and changes in life style, treatment options have included the aortocoronary bypass since the 1960s, and transluminal coronary angioplasty or percutaneous coronary intervention since 1977. Both surgical and interventional revascularization methods have been developed and improved continuously, while in parallel medicinal therapy has also made great advances. Thus, three treatment options now compete for the best therapy concept.

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Abbreviations

ACB:

Aortokoronarer Bypass

BMI:

Körpermassenindex („body mass index“)

FFR:

Fraktionelle Flussreserve („fractional flow reserve“)

KHK:

Koronare Herzkrankheit

MACE:

„Major adverse cardiovascular events“ (z. B. Re-PCI, Re-ACB, kardiovaskulärer Tod, nichttödlicher Herzinfarkt, Hospitalisation wegen Herzinsuffizienz, Schlaganfall)

NVL KHK:

Nationale Versorgungsleitlinie „Chronische KHK“

PCI:

Perkutane Koronarintervention

PTCA:

Perkutane transluminale Koronarintervention

RIVA:

Ramus interventricularis anterior

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Innere Medizin III(Kardiologie, Angiologie und internistische Intensivmedizin), Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06096, Halle/Saale, Deutschland

    M. Ruß & K. Werdan

  2. Deutsches Herzzentrum Berlin, Klinik für Innere Medizin, Berlin, Deutschland

    E. Fleck & K. Graf

  3. Klinik für Thorax- und Kardiovaskuläre Chirurgie, Heinrich-Heine-Universität, Düsseldorf, Deutschland

    E. Gams

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  1. M. Ruß
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  2. E. Fleck
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  3. K. Graf
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Ruß, M., Fleck, E., Graf, K. et al. Chronische koronare Herzkrankheit. Kardiologe 1, 55–70 (2007). https://doi.org/10.1007/s12181-007-0006-4

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