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Der Kardiologe

, Volume 12, Issue 5, pp 371–390 | Cite as

Management des akuten Koronarsyndroms

  • C. LiebetrauEmail author
  • A. Elsässer
  • H. Nef
  • H. Möllmann
CME
  • 1.3k Downloads

Zusammenfassung

Das akute Koronarsyndrom (ACS) ist häufig und prognostisch relevant. Insbesondere die kardialen Troponine sind neben dem 12-Kanal-EKG für die Risikostratifizierung und Diagnose wichtig. Mit der Verwendung der hochsensitiven Troponinbestimmung sind im klinischen Alltag eine schnelle Diagnosestellung und Behandlung von Patienten mit akutem Koronarsyndrom ohne ST-Streckenhebung (NSTE-ACS) möglich. Der Zeitpunkt der Koronarangiographie ist abhängig von der klinischen Situation und sollte bei Patienten mit STEMI ohne Verzögerung innerhalb von 120 min nach medizinischem Erstkontakt erfolgen. Bei NSTE-ACS-Patienten mit nachgewiesener Troponindynamik sollte die invasive Diagnostik innerhalb von 24 h, bei Hochrisikopatienten umgehend erfolgen. Unabhängig von der Revaskularisationsstrategie sollte eine duale antithrombozytäre Therapie mit Ticagrelor oder Prasugrel unter Berücksichtigung von Kontraindikationen für 12 Monate erfolgen. Clopidogrel ist nur noch bei Patienten mit einer Indikation zur oralen Antikoagulation oder bei Patienten mit stattgehabter zerebraler Blutung zu verwenden.

Schlüsselwörter

ST-Hebungsinfarkt Nicht-ST-Hebungsinfarkt Instabile Angina pectoris Troponinmessung Koronarangiographie 

Management of acute coronary syndrome

Abstract

Acute coronary syndrome (ACS) is frequent and prognostically relevant. Cardiac troponins I and T in addition to 12-lead electrocardiography (ECG) are important for risk stratification and diagnosis. The implementation of the highly sensitive cardiac troponin assays in the clinical practice enables a rapid diagnosis and treatment of patients with ACS without ST-segment elevation (NSTE-ACS). The timing of coronary angiography depends on the clinical situation and should be carried out in patients with STEMI without delay and within 120 min after first medical contact. In patients with NSTE-ACS and proven troponin dynamics invasive diagnostics should be carried out within 24 h of presentation and in high-risk patients without delay. Irrespective of the revascularization strategy a dual antiplatelet therapy with ticagrelor or prasugrel should be carried out for 12 months, taking contraindications into account. Clopidogrel is indicated only in patients who need oral anticoagulation or in patients after cerebral bleeding.

Keywords

ST-elevation myocardial infarction Non-ST-elevation myocardial infarction Unstable angina pectoris Troponin assay Coronary angiography 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Liebetrau erhielt Vortragshonorare von Abbott Laboratories, AstraZeneca, Bayer, Berlin-Chemie, Boehringer-Ingelheim, Lilly, Daiichi Sankyo, Merck und Pfizer. H. Nef erhielt Vortragshonorare von Abbott Vascular, AstraZeneca, Daiichi Sankyo, Bayer, Boehringer-Ingelheim, Pfizer, Bristol-Myers Squibb. A. Elsässer und H. Möllmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Deutsche Gesellschaft für Kardiologie - Herz- und Kreislaufforschung e.V. Published by Springer Medizin Verlag GmbH, ein Teil von Springer Nature - all rights reserved 2018

Authors and Affiliations

  • C. Liebetrau
    • 1
    • 2
    • 5
    Email author
  • A. Elsässer
    • 3
  • H. Nef
    • 1
    • 2
  • H. Möllmann
    • 4
  1. 1.Abteilung KardiologieKerckhoff Herz und Thorax ZentrumBad NauheimDeutschland
  2. 2.Medizinische Klinik I, Abteilung Kardiologie/AngiologieUniversitätsklinikum GießenGießenDeutschland
  3. 3.Klinik für Kardiologie, Herz-Kreislauf-ZentrumKlinikum OldenburgOldenburgDeutschland
  4. 4.Klinik für Innere Medizin ISt. Johannes-HospitalDortmundDeutschland
  5. 5.Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), partner-site RheinMainFrankfurt am MainDeutschland

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