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Dtsch Med Wochenschr 2015; 140(02): 97-103
DOI: 10.1055/s-0040-100589
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Akuter Thoraxschmerz
Georg Thieme Verlag Stuttgart

Das akute Koronarsyndrom

Acute coronary syndrome
Sebastian Reith
1   Medizinische Klinik I, Universitätsklinikum Aachen
,
Nikolaus Marx
1   Medizinische Klinik I, Universitätsklinikum Aachen
,
Alexander Kersten
1   Medizinische Klinik I, Universitätsklinikum Aachen
› Author Affiliations
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Publication History

Publication Date:
22 January 2015 (online)

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Zusammenfassung

Das akute Koronarsyndrom (ACS) ist eines der häufigsten Krankheitsbilder der prä- und innerklinischen Notfallmedizin. Dabei unterscheidet man die klinischen Entitäten instabile Angina (IAP), Nicht-ST-Hebungsinfarkt (NSTEMI) und ST-Hebungsinfarkt (STEMI) diagnostisch, prognostisch und bezüglich der optimalen Therapiestrategie voneinander. In den vergangenen Jahren verbesserte sich die Prognose des ACS durch die Reduktion sekundärer ischämischer Ereignisse kontinuierlich. Zu verdanken ist dies sowohl dem breiten und frühzeitigen Einsatz der perkutanen Koronarintervention (PCI), als auch zusätzlichen Innovationen bei der antithrombozytären Therapie mit wirksameren P2Y12-Rezeptorantagonisten. Auch neuen Antikoagulanzien, wie Fondaparinux und Bivalirudin haben zu der verbesserten Prognose beigetragen. Jedoch ist das erhöhte Blutungsrisiko – gerade unter den neuen potenteren Antithrombotika und Antikoagulanzien – ein fortbestehendes Problem. Zukünftige Studien müssen klären, inwiefern und durch welche Substanzkombination eine optimale Balance erzielt werden kann, bei der sowohl das Risiko für kardiovaskuläre Ereignisse als auch das Blutungsrisiko so gering wie möglich sind.

Abstract

The acute coronary syndrome (ACS) still remains a common disease in the preclinical as well as in the intrahospital emergency setting. Different clinical types of an ACS, such as unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) have to be differentiated diagnostically, prognostically and in terms of the best therapeutic strategy. Due to the broad and early use of percutaneous coronary intervention (PCI) as well as due to innovations in the antithrombotic and anticoagulation regime with the use of more effective P2Y12-receptor antagonists as well as the use of Fondaparinux and Bivalirudin, a continuous improvement of the prognosis and reduction of ischemic events could be achieved in ACS patients over the last few years. However, the increased bleeding rate, particularly when using those new substances, remains a relevant problem. Future studies are warranted to clarify if certain combinations of substances may be better suited to achieve the optimal balance between reduction of cardiovascular events on the one hand and bleeding risk on the other hand.

Schlüsselwörter

akutes Koronarsyndrom - antithrombozytäre Therapie - perkutane Koronarintervention

Key Words

acute coronary syndrome - antithrombotic therapy - percutaneous coronary intervention
 

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