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Kommentar zu den Leitlinien der European Society of Cardiology (ESC) zur Diagnose und Therapie des akuten Koronarsyndroms ohne ST-Strecken-Hebung (NSTE-ACS)

Commentary on the guidelines by the European Society of Cardiology (ESC) on the diagnosis and treatment of acute coronary syndrome without ST elevation (NSTE-ACS)

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Der Kardiologe Aims and scope

Zusammenfassung

Die Europäische Gesellschaft für Kardiologie hat 2007 eine überarbeitete Fassung der Leitlinie zur Diagnose und Therapie des akuten Koronarsyndroms ohne ST-Hebung herausgegeben, die die frühere Leitlinie aus 2002 ablöst. Diese kommentierte Übersetzung wurde von der Deutschen Gesellschaft für Kardiologie verabschiedet und bildet die aktuelle wissenschaftliche Evidenz ab. Erstmals erfolgte eine qualitative Bewertung der Studien, wie z. B. zeitgemäße Begleittherapie, Studiengröße, doppelblindes Studiendesign und harte Endpunkte. Außerdem ging der Sicherheitsaspekt einer Therapie im Sinne des „Efficacy-safety-Profils“ ein. Die Empfehlungen dieser Leitlinie sind praxisnah und erlauben ein zeitgemäßes Management von Patienten mit akutem Koronarsyndrom.

Abstract

In 2007, the European Society of Cardiology published updated guidelines on the diagnosis and treatment of acute coronary syndrome without ST elevation, which replace the previous guidelines of 2004. This commented translation is endorsed by the German Cardiac Society and reflects the current scientific evidence. For the first time, the study quality was weighted, e.g. contemporary adjunctive therapy, study size, double blind design and hard endpoints. In addition, the safety aspect was considered in terms of an efficacy/safety profile. The recommendations are close to clinical practice and allow appropriate management of acute coronary syndrome patients.

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Abbreviations

ACC:

American College of Cardiology

ACE:

Angiotensin-converting-Enzym

ACS:

Acute Coronary Syndrome

ACT:

Activated Clotting Time

ADP:

Adenosine Diphosphat

AHA:

American Heart Association

aPTT:

Activated Partial Thromboplastin Time

AMI:

Akuter Myokardinfarkt

ASS:

Azetylsalizylsäure (Aspirin)

BNP:

Brain Natriuretic Peptide

CABG:

Coronary Bypass Graft

CCS:

Canadian Cardiovascular Society

CI:

Confidence interval

CK:

Creatine Kinase

CK-MB:

Creatine Kinase Myocardial Band

(hs)CRP:

C-reaktives Protein

CT:

Computertomographie

cTnT / cTnI:

Cardiac Troponin T oder Cardiac Troponin I

DES:

Drug eluting stent

DTI:

Direkter Thrombininhibitor

EKG:

Elektrokardiogramm

EF:

Ejektionsfraktion

ESC:

European Society of Cardiology

Factor-Xa:

Activated Factor X

FFP:

Fresh frozen plasma

GFR:

Glomerular Filtration Rate

GPIIb/IIIa:

Glypoprotein IIb–IIIa

HIT:

Heparin-induzierte Thrombozytopenie

HR:

Hazard Ratio

IU:

International Units

LV:

links-ventrikulär

LVEF:

links-ventrikuläre Ejektionsfraktion

MRT:

Magnetresonanztomographie

NNT:

Numbers Needed to Treat

NSTE-ACS:

Non-ST-Elevation Acute Coronary Syndromes

NSTEMI:

Non-ST Elevation Myocardial Infarction

NT-proBNP:

N-terminal Prohormone Brain Natriuretic peptide

OR:

Odds Ratio

PCI:

Percutaneous Coronary Intervention

RR:

Risk Ratio

STEMI:

ST-Elevation Myocardial Infarction

UFH:

Unfractionated Heparin

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Der korrespondierende Autor weist auf folgende Beziehung hin: hinterlegt zur Einsichtnahme bei der DGK.

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  1. Kerckhoff-Klinik, Herz- und Thoraxzentrum, Bad Nauheim, Deutschland

    C.W. Hamm

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Hamm, C. Kommentar zu den Leitlinien der European Society of Cardiology (ESC) zur Diagnose und Therapie des akuten Koronarsyndroms ohne ST-Strecken-Hebung (NSTE-ACS). Kardiologe 3, 81–100 (2009). https://doi.org/10.1007/s12181-009-0177-2

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