Medikamentöse Therapie nach Koronarinterventionen

Abstract

Guideline-orientated medical treatment plays a decisive role for peri-interventional and longterm prognosis of patients with symptomatic coronary artery disease undergoing coronary intervention. Besides effective antiplatelet therapy, treatment with beta-blockers, statins, ACE-Inhibitors and AT1-Antagonists has a relevant impact on further outcome in certain risk groups and is underrepresented in real-world clinical practise. Since atherosclerosis represents a dynamic process outlasting coronary intervention, sustaining treatment of modifiable risk factors is of high importance. In most cases primary presentation for PCI represent the first and only chance for the interventional cardiologist to optimize medical treatment und thus improving cardiovascular prognosis. The aim of the present article is to give an overview over concomitant medical treatment strategies in patients undergoing coronary intervention and to discuss their role for cardiovascular prognosis in the context of current studies and evidence base guidelines.

Kernaussagen

• Eine leitliniengerechte medikamentöse Therapie ist von entscheidender Bedeutung für die periinterventionelle und langfristige Prognose bei Patienten mit symptomatischer KHK und Koronareingriff.

• Dabei kommt neben der effektiven antithrombozytären Therapie einer Behandlung mit Betablockern, CSE-Hemmern, ACE-Inhibitoren bzw. AT1-Antagonisten in bestimmten Risikogruppen eine entscheidene Bedeutung zu und ist in der „real-world practise” zum Teil unterrepräsentiert.

• Da die Artherosklerose auch über die Intervention hinaus einem dynamischen Prozess unterliegt, ist eine nachhaltige Modifikation behandelbarer Risikofaktoren wichtig. In vielen Fällen ergibt sich erst durch die primäre Vorstellung zur Koronarintervention die Möglichkeit, das kardiovaskuläre Risikoprofil durch die medikamentöse Optimierung präventiv und nachhaltig zu beeinflussen und neben dem eigentlichen Koronareingriff auch hierdurch die Prognose des Patienten entscheidend zu verbessern.

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