Die chronische koronare Herzkrankheit/das chronische Koronarsyndrom – Was sagen die deutschen und die europäischen Leitlinien?

Zusammenfassung

Von der Volkskrankheit „koronare Herzkrankheit“ (KHK) ist jeder zehnte 40- bis 79-Jährige in Deutschland betroffen. Basierend auf den Leitlinien der Europäischen Gesellschaft für Kardiologie zu chronischen Koronarsyndromen (CCS) und zur Myokardrevaskularisation sowie der Nationalen VersorgungsLeitlinie (NVL) „Chronische KHK“ werden evidenz- und expertenbasierte Empfehlungen zur Diagnosestellung sowie zur Behandlung und Betreuung der KHK-/CCS-Patienten dargestellt, mit Fokus auf nichtinvasive und invasive Myokardischämiediagnostik sowie medikamentöse und myokardrevaskularisierende Maßnahmen. Voneinander abweichende Empfehlungen der einzelnen Leitlinien in seltenen Fällen erweitern den Ermessensspielraum des Arztes. Das Aufzeigen des Notwendigen und Angemessenen sind wesentliche Intentionen dieser Leitlinien, mit dem Ziel, die Qualität der Patientenversorgung auf bestmöglichem Niveau zu halten.

Abstract

Widespread “coronary heart disease” affects one in ten of the population of the 40 – 79-year-old in Germany. The European ESC-Guidelines on “Diagnosis and treatment of patients with chronic coronary syndromes” as well as on “Myocardial revascularization” and also the German National Disease Management Guideline “Chronic Coronary Artery Disease” comprise evidence- and expert-based recommendations for diagnosis and treatment and care of patients with stable coronary artery disease/chronic coronary syndromes. The focus is on non-invasive and invasive diagnosis of myocardial ischaemia, on medical treatment and on myocardial revascularization. Recommendations of the respective guidelines telling us various “truths” in rare cases broaden the decision latitude of the physician. Defining mandatory and appropriate measures are essential aims of these guidelines to keep patient care on its best level.

Was ist wichtig?

• Als Kardiologe wird man von der Deutschen Gesellschaft für Kardiologie (DGK) und European Society of Cardiology (ESC) zeitnah mit aktuellen Leitlinien versorgt. Warum soll man sich also dann noch mit der Nationalen VersorgungsLeitlinie „Chronische KHK“ (NVL KHK) [1] beschäftigen? Der Anreiz dafür ist weniger die auf Deutsch abgefasste Leitlinie und auch nicht die sehr hohe Methodenqualität. Vielmehr sind es die intersektorale Ausrichtung und die Einbindung der Patienten.

• Bei der 2019 erschienenen 5. Auflage der NVL KHK [1] haben Delegierte von 15 Fachgesellschaften und Organisationen mitgearbeitet. Neben einer Lang- sowie Kurzfassung und Praxishilfen gibt es auch eine NVL-PatientenLeitlinie.

• Auch die ESC hat ihre entsprechende Leitlinie aktualisiert [2].

• Die Methodik der Evidenz- und Empfehlungsgraduierung der NVL KHK weicht mit ihren Empfehlungsgraden von der uns Kardiologen bekannten Graduierung der ESC-Leitlinien ab ([Tab. 1]).

Schlüsselwörter

ESC-Leitlinie Chronische Koronarsyndrome - Nationale VersorgungsLeitlinie Chronische KHK (NVL KHK) - ESC-Leitlinie Myokardrevaskularisation

Key words

ESC Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes - ESC/EACTS Guidelines on Myocardial Revascularization - German National Disease Management Guideline on Stable Coronary Artery Disease

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