Perioperatives akutes Koronarsyndrom

Kernaussagen

Das perioperative akute Koronarsyndrom ist eine große Herausforderung für alle begleitenden Disziplinen. Der perioperative Myokardinfarkt hat eine sehr ernste Prognose. Die Gesamtmortalität der Patienten mit einer KHK, die nach einem größeren, nicht kardiochirurgischen Eingriff einen Troponinanstieg zeigten, liegt bei durchschnittlich 22 % [51] [53] und ist somit deutlich höher als beim akuten Koronarsyndrom [68]. Ein großes Augenmerk ist besonders auf Prävention und Risikoabschätzung zu legen. So könnte mit einer vorgeschalteten Diagnostik das operative als auch das kardiale Risiko deutlich reduziert werden. Nicht nur eine operationsbegleitende präventive Medikation und angepasste Narkoseführung sorgen für weniger Probleme, sondern auch und gerade eine entsprechende Sensibilisierung des Personals. Denn die klassischen Symptome des akuten Koronarsyndroms sind in der postoperativen Phase nur schwach ausgeprägt. Allzu oft sind die Symptome überlagert oder werden falsch interpretiert. Im Vordergrund steht also das klinische Erkennen eines akut erkrankten Patienten, um beim geringsten Verdacht auf ein kardiales Ereignis möglichst schnell eine zielgerichtete Diagnostik einzuleiten.

Die Diagnostik besteht primär aus den hämodynamischen Parametern, einem 12-Kanal-EKG und der Bestimmung der Herzenzyme. Verdichten sich die Hinweise, muss man den Patienten konsequent überwachen und umgehend einen interventionellen Kardiologen hinzuziehen. Kurze Wege zur raschen Intervention bedürfen einer entsprechenden Logistik mit strukturierten Abläufen. Nur in gemeinsamer Diskussion und bei Abwägung der Risiken einer Intervention gegenüber einer konservativeren Vorgehensweise kann eine sinnvolle, zielgerichtete Therapie ausgearbeitet werden.

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