Abstract
Acute coronary syndromes denote the acute life-threatening phases of coronary heart disease. Clinical presentation, EKG, and CK-MB measurements are insufficient to evaluate patients without ST elevations. Serial determinations of troponin T or troponin I within 4 to 6 hours after arrival in hospital disclose minor myocardial injury in patients presenting as unstable angina. This finding allows superior risk stratification and may contribute to cost-effectiveness. Without elevated troponins the risk for death or myocardial infarction during 30 days follow-up is not more than 1%. The lack of elevated troponins does not implicate that these patients do not have coronary artery disease. Patients with positive evidence of troponins represent a high risk group who should be hospitalized and further evaluated. The risk for myocardial infarction and death in 30 days is approximately 20%. This subgroup benefits substantially from treatment with glycoprotein IIb/III a antagonists independent of a coronary intervention.
Zusammenfassung
Unter dem Begriff „akutes Koronarsyndrom“ werden die akuten, lebensbedrohlichen Phasen der koronaren Herzerkrankung zusammengefaßt. Klinik, EKG und CK-MB Bestimmungen sind ungenügend, Patienten ohne ST-Streckensenkung sicher zu evaluieren. Durch eine serielle Bestimmung von Troponin T oder Troponin I innerhalb von 4 bis 6 Stunden nach Aufnahme werden bei etwa einem Drittel der Patienten, die klinisch als instabile Angina klassifiziert werden, Mikrozellschädigungen („minor myocardial injury“) nachgewiesen. Dieser Befund erlaubt eine überlegene Risikostratifizierung und kann auch zur Kosteneffektivität beitragen. Ohne erhöhtes Troponin liegt das Risiko für Tod oder Myokardinfarkt nicht höher als 1%. Andere lebensbedrohliche Erkrankungen sind selbstverständlich auszuschließen. Der fehlende Nachweis von erhöhten Troponinen schließt eine koronare Herzerkrankung nicht aus. Patienten mit positivem Troponin Test sind als Hochrisikogruppe zu betrachten und gehören weiter stationär beobachtet und abgeklärt. Das Risiko für Myokardinfarkt oder Tod im 30 Tage Zeitraum liegt bei etwa 20%. Diese Subgruppe profitiert von der Behandlung mit Glykoprotein IIb/IIIa Antagonisten mit und ohne Koronarintervention.
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Hamm, C.W. (2000). Risikostratifizierung bei akutem Koronarsyndrom. In: Arntz, HR., Schuster, HP. (eds) Die Notfalltherapie bei akutem Myokardinfarkt. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57713-0_8
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DOI: https://doi.org/10.1007/978-3-642-57713-0_8
Publisher Name: Steinkopff, Heidelberg
Print ISBN: 978-3-7985-1247-4
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