Download PDF
Der Klinikarzt 2019; 48(04): 148-154
DOI: 10.1055/a-0889-0057
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Der alte ACS-Patient

Konservative oder interventionelle Therapie?
Luise Gaede
1   Medizinische Klinik 2, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen
,
Helge Möllmann
2   Klinik für Innere Medizin I, Kardiologie, Nephrologie, Intensivmedizin, Rhythmologie St.-Johannes-Hospital, Dortmund
› Author Affiliations
Further Information

Publication History

Publication Date:
03 May 2019 (online)

Also available at
    Permissions and Reprints

ZUSAMMENFASSUNG

Der alte Patient mit einem akuten Koronarsyndrom (ACS) wird häufig aufgrund des Alters, Vorerkrankungen und auch erhöhtem Blutungsrisiko nicht evidenzbasiert therapiert. Dies gilt sowohl für die medikamentöse als auch die interventionelle Therapie. Valide Daten zeigen jedoch deutlich, dass gerade auch alte Patienten von einer Leitlinien-konformen Therapie – vor allem auch der interventionellen Therapie und der Revaskularisation – profitieren.

 

  • Literatur

  • 1 Dai X, Busby-Whitehead J, Alexander KP. Acute coronary syndrome in the older adults. J Geriatr Cardiol 2016; 13: 101-108
    PubMedGoogle Scholar
  • 2 Brieger D, Eagle K, Goodman S. et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: Insights from the global registry of acute coronary events. Chest 2004; 126: 461-469
    CrossrefPubMedGoogle Scholar
  • 3 Freisinger E, Fuerstenberg T, Malyar NM. et al. German nationwide data on current trends and management of acute myocardial infarction: Discrepancies between trials and real-life. Eur Heart J 2014; 35: 979-988
    CrossrefPubMedGoogle Scholar
  • 4 Rosengren A, Wallentin L, Simoons M. et al. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey. Eur Heart J 2006; 27: 789-795
    CrossrefPubMedGoogle Scholar
  • 5 Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST -segment elevation The Task Force for the management of acute myocardial infarction. Eur Heart J 2018; 39: 119-177
    CrossrefPubMedGoogle Scholar
  • 6 Moscucci M, Fox KAA, Cannon CP. et al. Predictors of major bleeding in acute coronary syndromes: The Global Registry of Acute Coronary Events (GRACE). Eur Heart J 2003; 24: 1815-1823
    CrossrefPubMedGoogle Scholar
  • 7 Gallagher S, Knight C. Contrast-induced nephropathy in primary percutaneous coronary intervention. Heart 2011; 97: 1723-1725
    CrossrefPubMedGoogle Scholar
  • 8 Skolnick AH, Alexander KP, Chen AY. et al. Characteristics, Management, and Outcomes of 5,557 Patients Age ≥ 90 Years With Acute Coronary Syndromes. Results From the CRUSADE Initiative. J Am Coll Cardiol 2007; 49: 1790-1797
    CrossrefPubMedGoogle Scholar
  • 9 Devlin G, Gore JM, Elliott J. et al. Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: The Global Registry of Acute Coronary Events. Eur Heart J 2008; 29: 1275-1282
    CrossrefPubMedGoogle Scholar
  • 10 Bauer T, Koeth O, Jünger C. et al. Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction. Eur Heart J 2007; 28: 2873-2878
    CrossrefPubMedGoogle Scholar
  • 11 De Boer MJ, Ottervanger JP, Van’T Hof AWJ. et al. Reperfusion therapy in elderly patients with acute myocardial infarction: A randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol 2002; 39: 1723-1728
    CrossrefPubMedGoogle Scholar
  • 12 Bueno H, Betriu A, Heras M. et al. Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio en Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J 2011; 32: 51-60
    CrossrefPubMedGoogle Scholar
  • 13 Alexander KP, Chen AY, Roe MT, Investigators C. et al. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. [Erratum appears in JAMA. 2006 Feb 8; 295(6): 628]. Jama 2005; 294: 3108-3116
    CrossrefPubMedGoogle Scholar
  • 14 Neumann F-J, Sousa-Uva M, Ahlsson A. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2018; 1-96
    PubMedGoogle Scholar
  • 15 Valgimigli M, Bueno H, Byrne RA. et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur J Cardio-Thoracic Surg 2017; 213-254
    PubMedGoogle Scholar
  • 16 Roffi M, Patrono C, Collet J-P. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2016; 37: 1101-1106
    CrossrefPubMedGoogle Scholar
  • 17 Bach RG, Cannon CP, Weintraub WS. The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. ACC Curr J Rev 2004; 13: 53-54
    CrossrefPubMedGoogle Scholar
  • 18 Alexander KP, Newby LK, Cannon CP. et al. Acute coronary care in the elderly, part I. Non-ST-segment-elevation acute coronary syndromes: A scientific statement for healthcare professionals from the American heart association council on clinical cardiology. Circulation 2007; 115: 2549-2569
    CrossrefPubMedGoogle Scholar
  • 19 Singh M, Stewart R, White H. Importance of frailty in patients with cardiovascular disease. Eur Heart J 2014; 35: 1726-1731
    CrossrefPubMedGoogle Scholar
  • 20 Kirchhof P, Benussi S, Kotecha D. et al. ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37: 2893-2962
    CrossrefPubMedGoogle Scholar
  • 21 Dewilde WJM, Oirbans T, Verheugt FWA. et al. WOEST study investigators. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet (London, England) 2013; 381: 1107-1115
    CrossrefPubMedGoogle Scholar
  • 22 Gibson CM, Mehran R, Bode C. et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2016; 375: 2423-2434
    CrossrefPubMedGoogle Scholar
  • 23 Cannon CP, Bhatt DL, Oldgren J. et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N Engl J Med 2017; 377: 1513-1524
    CrossrefPubMedGoogle Scholar
  • 24 Reiter M, Twerenbold R, Reichlin T. et al. Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays. Eur Heart J 2011; 32: 1379-1389
    CrossrefPubMedGoogle Scholar
  • 25 Liebetrau C, Gaede L, Wolter JS. et al. Release kinetics of high-sensitivity cardiac troponins I and T and troponin T upstream open reading frame peptide (TnTuORF) in clinically induced acute myocardial infarction. Biomarkers 2017; 22: 304-310
    CrossrefPubMedGoogle Scholar
  • 26 Liebetrau C, Nef HM, Dörr O. et al. Release kinetics of early ischaemic biomarkers in a clinical model of acute myocardial infarction. Heart 2014; 100: 652-657
    CrossrefPubMedGoogle Scholar