Management von Patienten mit akutem Koronarsyndrom und koronarer Mehrgefäßerkrankung

Zusammenfassung

Der Anteil an Patienten mit koronarer Mehrgefäßerkrankung bei Patienten mit akutem Koronarsyndrom (ACS) variiert je nach Alter und Risikokonstellation. Bei Patienten mit ST-Strecken-Hebungsinfarkt (STEMI) wurde der prognostische Vorteil der vollständigen Revaskularisation in mehreren randomisierten Studien gezeigt. Entsprechende Daten fehlen bisher bei Patienten mit akutem Koronarsyndrom ohne ST-Strecken-Hebungen (NSTE-ACS), eine große randomisierte Studie ist jedoch vor Kurzem gestartet. Im infarktbedingten kardiogenen Schock ist die frühe Revaskularisation die einzige, mit in randomisierten Studien belegten Daten, prognoseverbessernde Therapie, allerdings sollte sich in der Akutphase die perkutane Koronarintervention (PCI) auf die Culprit Lesion beschränken.

Abstract

The proportion of patients with multivessel coronary artery disease in patients with acute coronary syndrome (ACS) varies according to age and risk profile. In patients with ST-segment elevation myocardial infarction (STEMI), the prognostic benefit of complete revascularization has been demonstrated in several randomized trials. Corresponding data are lacking so far in patients with acute coronary syndrome without ST-segment elevation (NSTE-ACS), but a large randomized trial has started recently. In infarct-related cardiogenic shock, early revascularization is the only prognosis-improving therapy with data supported by randomized trials; however, in the acute phase, PCI should be limited to culprit lesion.

Schlüsselwörter

Revaskularisation - akutes Koronarsyndrom - koronare Mehrgefäßerkrankung

Keywords

acute coronary syndrome - multivessel coronary artery disease - revascularization

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