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DOI: 10.1055/s-2005-871849
© Georg Thieme Verlag Stuttgart · New York
Prähospitale Lyse des akuten Herzinfarkts
Kombinierte Thrombolyse und InterventionPublication History
Publication Date:
24 June 2005 (online)
![](https://www.thieme-connect.de/media/notfall-hausarztmedizin/200505/lookinside/thumbnails/10.1055-s-2005-871849-1.jpg)
Zusammenfassung
Ist ein ST-Streckenhebungsinfarkt durch klar definierte EKG-Zeichen eines 12-Kanal-EKGs bei entsprechender Klinik nachgewiesen, kann die Therapiestrategie mehreren Wegen folgen. Wichtig für die Wahl der Strategie sind dabei die Symptomdauer, die Erreichbarkeit eines qualifizierten Interventionszentrums, die Logistik des Rettungsdienstes, der klinische Zustand des Patienten, das Vorhandensein von Kontraindikationen gegen eine Lysetherapie und die Präferenz des Patienten selbst, die bei der Umsetzung der Leitlinien der Deutschen Gesellschaft für Kardiologie mitberücksichtigt werden müssen. Scheinbar steht die Thrombolyse in Konkurrenz zur Intervention, beide Verfahren können sich aber auch ergänzen. Beispielsweise kann der Thrombolyse routinemäßig die Intervention folgen, die so genannte „Facilitated PCI”. Eine Ausweitung des Facilitated-PCI-Verfahrens könnte durch Kombination mit Thrombolyse in niedriger Dosis mit zusätzlicher Gabe eines Gp IIb/IIIa-Rezeptorblockers erreicht werden. Eine weitere Möglichkeit besteht in der so genannten Rescue-Intervention. Im Rahmen der Verbringung eines Patienten zur primären PCI ist die Gabe eines Gp IIb/IIIa-Rezeptorblockers bereits durch den Notarzt oder im peripheren Krankenhaus in Vorbereitung zur Intervention eine weitere therapeutische Option.
Summary
Once an ST elevation myocardial infarction has been confirmed by clearly defined ECG signs of a 12-channel ECG recording, in a patient with relevant clinical findings, the therapeutic strategy has a choice of several options. Of importance when deciding what strategy to follow are the parameters duration of symptoms, distance to a specialised percutaneous coronary intervention (PCI) centre, the logistics of the medical rescue service, the clinical state of the patient, the presence of contraindications for thrombolytic therapy, and the patient's own preference, all of which need to be taken into account when implementing the guidelines of the German Society for Cardiology. Although thrombolysis appears to be in competition with PCI, the two procedures can complement each other, for example, thrombolysis can be applied routinely following PCI - so-called facilitated PCI. This latter procedure might also be expanded by combining it with thrombolysis at a low dose, with the additional administration of a GpIIb/IIIa receptor blocker. Another option is the so-called rescue intervention. During transport of the patient to primary PCI, administration of a GpIIb/IIIa receptor blockers already by the emergency physician or in the peripheral hospital in preparation for coronary intervention is yet another option.
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Anschrift des Verfassers
Prof. Dr. med. Hans-Richard Arntz
Charité, Campus Benjamin Franklin, Medizinische Klinik II
Hindenburgdamm 30
12200 Berlin
Email: hans-richard.arntz@charite.de