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Der Klinikarzt 2006; 35(7): 288-294
DOI: 10.1055/s-2006-949112
In diesem Monat

© Georg Thieme Verlag Stuttgart · New York

Zeit ist Myokard - Frühbehandlung des akuten Koronarsyndroms von besonderer Bedeutung

Time is Myocardium - Early Treatment of Acute Coronary Syndromes is Particularly ImportantH.-R. Arntz1
  • 1Kardiologie/Pulmologie, Medizinische Klinik II, Campus Benjamin Franklin, Charité, Berlin (Direktor: Prof. Dr. H.-P. Schultheiss)
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Publication History

Publication Date:
19 July 2006 (online)

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Bei der Akuttherapie des akuten Koronarsyndroms ist die Frühphase von besonderer Bedeutung - einerseits müssen lebensbedrohliche tachykarde Rhythmusstörungen vermieden werden, andererseits kann eine schnellstmögliche kausale Therapie dazu beitragen, das Ausmaß der Folgeschäden gering zu halten. So ist beim ST-Elevationsinfarkt besonders wichtig, das akut verschlossene Gefäß mithilfe der Lyse oder der perkutanen Koronarintervention schnellstmöglich wieder zu eröffnen. Gelingt die Reperfusion frühzeitig, lassen sich relevante Myokardanteile retten. Im Vordergrund der Bemühungen beim Nicht-ST-Hebungsinfarkt dagegen stehen andere Ziele. Hier muss vor allem das Fortschreiten des thrombotischen Geschehens aufgehalten und ein kompletter Verschluss durch gezielte antikoagulatorische Maßnahmen (Hemmung von Thrombozytenaggregation und -aktivierung sowie Koagulation) verhindert werden. Die einzelnen Studienergebnisse zur Therapie des akuten Koronarsyndroms sind allerdings so umfangreich, dass sie für den Einzelnen fast nicht mehr überschaubar sind. Abhilfe schaffen sollen aktuelle Leitlinien - wie die des European Resuscitation Council (ERC), die versuchen, die wesentlichen Erkenntnisse zusammenzufassen und zu komprimieren.

For the immediate treatment of acute coronary syndromes, the early phase is of special significance - not only must life-threatening tachycardic rhythm disorders be avoided, but also rapid causal treatment can help minimize the severity of negative sequelae. Thus, in the case of an ST-elevation myocardial infarction it is of particular importance to open acutely blocked vessels by lysis or percutaneous coronary intervention as quickly as possible. If early reperfusion is successful, relevant portions of the myocardium can be saved. In the management of non-ST-elevation infarction, however, different priorities apply. Here, the main objective is to halt the progression of the thrombotic process, and prevent complete occlusion by specific anticoagulation measures (inhibition of platelet aggregation and activation, anticoagulants). The reported results of studies of the treatment of acute coronary syndrome are, however, so voluminous as to be confusing for the average individual. Here, help is available in the form of current guidelines, such as those of the European Resuscitation Council (ECR), which summarise and compress the major results.

Key Words

acute coronary syndrome - STEMI - NSTEMI - instable angina pectoris - acute intervention - reperfusion - anticoagulation - guidelines

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1 CLopidogrel as Adjunctive ReperfusIon Therapy

2 Facilitated INtervention with Enhanced reperfusion Speed to Stop Events

Anschrift des Verfassers

Prof. Dr. Hans-Richard Arntz

Charité, Campus Benjamin Franklin

Med. Klinik II, Kardiologie/Pulmologie

Hindenburgdamm 30

12200 Berlin