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Kommentar zu den 2014-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) und der Europäischen Gesellschaft für Anästhesiologie (ESA) zum Management kardiovaskulärer Erkrankungen bei nicht-kardialen chirurgischen Eingriffen

Comment on the 2014 Guidelines of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) for the management of cardiovascular disease in non-cardiac surgery

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Der Kardiologe Aims and scope

Zusammenfassung

Die 2014 veröffentlichten ESC-Leitlinien zur kardiovaskulären Beurteilung und Management von Patienten, die für nicht-kardiale Operationen vorgesehen sind, geben Empfehlungen zur kardialen Risikostratifizierung des Patienten und zur Klassifizierung der geplanten operativen Eingriffe. Neben der präoperativen Diagnostik wurden die Strategien zur Risikoreduktion grundlegend überarbeitet. Dies betrifft insbesondere den differenzierten Einsatz von β-Blockern, ARB/ACE-Hemmer und Statinen sowie den fallbasierten Umgang mit Komorbiditäten. Zudem wurden die Empfehlungen zum perioperativen Gebrauch von Thrombozytenhemmern und oralen Antikoagulanzien aktualisiert. Die Strategien zur stufenweise präoperativen Risikoeinschätzung und -reduktion sind in einer Synopsis (Abb. 1 und Tab. 1) kondensiert und übersichtlich zusammengefasst.

Abstract

The 2014 ESC Guidelines on “Non-cardiac surgery: cardiovascular assessment and management” summarize current knowledge to perform adequate risk assessment and reduction in patients with and without cardiovascular history scheduled for non-cardiac surgery. A stepwise approach for preoperative diagnostic procedures and risk assessment is provided and recommendations for the use of β-blockers, ARBs/ACE-inhibitors and statins as well as the individualized treatment of comorbidities. Further, a detailed analysis and recommendations for the management of dual antiplatelet therapy and anticoagulation is given. Overall strategies for preoperative risk reduction and assessment are summarized in a 7-step scheme and in a table synopsis.

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Abb. 1

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Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    M. Kelm

  2. Medizinische Klinik I, Kardiologie, Angiologie, Intensivmedizin, Herz-Thorax-Zentrum, Klinikum Fulda, Fulda, Deutschland

    V. Schächinger

  3. Klinik für Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum Homburg/Saar, Homburg/Saar, Deutschland

    M. Böhm

  4. Klinik für Kardiologie und Allg. Innere Medizin, Klinikum Solingen, Solingen, Deutschland

    H. M. Hoffmeister

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Correspondence to M. Kelm.

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Kelm, M., Schächinger, V., Böhm, M. et al. Kommentar zu den 2014-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) und der Europäischen Gesellschaft für Anästhesiologie (ESA) zum Management kardiovaskulärer Erkrankungen bei nicht-kardialen chirurgischen Eingriffen. Kardiologe 9, 283–288 (2015). https://doi.org/10.1007/s12181-015-0006-8

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