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Notfallmedizin up2date 2013; 8(4): 269-283
DOI: 10.1055/s-0033-1346882
Reanimation
Georg Thieme Verlag KG Stuttgart · New York

Notfallbehandlung bei akutem Koronarsyndrom unter dem Blickwinkel der aktuellen STEMI-Leitlinien

Holger Thiele
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Publication History

Publication Date:
16 December 2013 (online)

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Notfallbehandlung bei akutem Koronarsyndrom unter dem Blickwinkel der aktuellen STEMI-LeitlinienKardiologie up2date 2014; 10(03): 195-209
DOI: 10.1055/s-0034-1390765

Kernaussagen

  • Das akute Koronarsyndrom (ACS) setzt sich aus den Entitäten ST-Streckenhebungsinfarkt (STEMI), Nicht-ST-Streckenhebungsinfarkt (NSTEMI) und instabile Angina zusammen.

  • Neben der klinischen Symptomatik stellt ein 12-Kanal-EKG das wichtigste und schnellste diagnostische Kriterium für einen STEMI dar. Die sofortige Ableitung und korrekte Interpretation eines 12-Kanal-EKG ist durch den medizinischen Erstkontakt unumgänglich und sollte in weniger als 10 Minuten erfolgen.

  • Die Therapie beim ACS besteht aus einer symptomatischen und kausalen Therapie.

  • Aufgrund möglicher negativer Effekte sollte die Sauerstoffgabe nicht mehr routinemäßig erfolgen.

  • Die zeitnahe primäre PCI ist das bevorzugte Reperfusionsverfahren.

  • Die Fibrinolyse spielt bei guter Netzwerkbildung in Deutschland keine Rolle mehr.

  • Der Notarzt ist verantwortlich für die Einleitung einer Triage zur Reperfusionstherapie, und er hat die Entscheidung zur primären PCI und möglichst zur Umgehung von Nicht-PCI-Krankenhäusern zu fällen.

  • Zur kausalen Therapie gehört neben der zeitnahen Revaskularisation die Gabe von Antithrombinen und Thrombozytenaggregationshemmern.

  • Die Zeit spielt für die Reperfusionstherapie bei STEMI eine sehr wichtige Rolle.

 

  • Literatur

  • 1 Schnoor J, Gillmann B, Pavlakovic G et al. [Characteristics of repeated emergency physician use]. Notarzt 2006; 22: 141-146
    Article in Thieme ConnectGoogle Scholar
  • 2 Lowel H, Meisinger C, Heier M et al. [Myocardial infarction and coronary mortality in Southern Germany]. Dtsch Ärztebl 2006; 103: 616-622
    Google Scholar
  • 3 Widimsky P, Wijns W, Fajadet J et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010; 31: 943-957
    CrossrefGoogle Scholar
  • 4 McManus DD, Gore J, Yarzebski J et al. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011; 124: 40-47
    CrossrefGoogle Scholar
  • 5 Steg PG, James SK, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569-2619
    CrossrefPubMedGoogle Scholar
  • 6 Van de Werf F, Bax J, Betriu A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008; 29: 2909-2945
    CrossrefPubMedGoogle Scholar
  • 7 Handley AJ, Koster R, Monsieurs K et al. European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2005; 67 Suppl 1: S7-S23
    CrossrefPubMedGoogle Scholar
  • 8 Nolan JP, Hazinski MF, Billi JE et al. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2010; 81 Suppl 1: e1-e25
    CrossrefGoogle Scholar
  • 9 Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. Eur Heart J 2012; 33: 2551-2567
    CrossrefGoogle Scholar
  • 10 Wijesinghe M, Perrin K, Ranchord A et al. Routine use of oxygen in the treatment of myocardial infarction: systematic review. Heart 2009; 95: 198-202
    Google Scholar
  • 11 Stegman BM, Newby LK, Hochman JS et al. Post-myocardial infarction cardiogenic shock is a systemic illness in need of systemic treatment: Is therapeutic hypothermia one possibility?. J Am Coll Cardiol 2012; 59: 644-647
    CrossrefGoogle Scholar
  • 12 Eitel I, Desch S, De Waha S et al. Long-term prognostic value of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction. Heart 2011; 97: 2038-2045
    CrossrefGoogle Scholar
  • 13 Eitel I, Desch S, Fuernau G et al. Prognostic significance and determinants of myocardial salvage assessed by cardiovascular magnetic resonance in acute reperfused myocardial infarction. J Am Coll Cardiol 2010; 55: 2470-2479
    CrossrefGoogle Scholar
  • 14 Reimer KA, Lowe JE, Rasmussen MM et al. The wavefront phenomenon of ischemic cell death: myocardial infarct size vs. duration of coronary occlusion in dogs. Circulation 1977; 56: 786-794
    CrossrefPubMedGoogle Scholar
  • 15 Terkelsen CJ, Lassen JF, Norgaard BL et al. Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutaneous coronary intervention. Eur Heart J 2005; 26: 770-777
    CrossrefGoogle Scholar
  • 16 Terkelsen CJ, Sorensen JT, Maeng M et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA 2010; 304: 763-771
    CrossrefPubMedGoogle Scholar
  • 17 Hamm CW, Arntz HR, Bode C et al. Leitlinien: Akutes Koronarsyndrom (ACS). Teil 2: Akutes Koronarsyndrom mit ST-Hebung. Z Kardiol 2004; 93: 324-341
    CrossrefGoogle Scholar
  • 18 Armstrong PW, Gershlick AH, Goldstein P et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2013; 368: 1379-1387
    CrossrefGoogle Scholar
  • 19 Gershlick AH, Stephens-Loyd A, Hughes S et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med 2005; 353: 2758-2768
    CrossrefGoogle Scholar
  • 20 Wijeysundera HC, Vijayaraghavan R, Nallamothu BK et al. Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: A meta-analysis of randomized trials. J Am Coll Cardiol 2007; 49: 422-430
    CrossrefGoogle Scholar
  • 21 Desch S, Eitel I, Rahimi K et al. Timing of invasive treatment after fibrinolysis in ST elevation myocardial infarction – a meta-analysis of immediate or early routine versus deferred or ischemia-guided randomised controlled trials. Heart 2010; 96: 1695-1702
    CrossrefGoogle Scholar
  • 22 Palmerini T, Biondi-Zoccai G, Della Riva D et al. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: Evidence from a comprehensive network meta-analysis. J Am Coll Cardiol 2013; 62: 496-504
    CrossrefGoogle Scholar
  • 23 Vlaar PJ, Mahmoud KD, Holmes jr. DR et al. Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: A pairwise and network meta-analysis. J Am Coll Cardiol 2011; 58: 692-703
    CrossrefPubMedGoogle Scholar
  • 24 Jang JS, Jin HY, Seo JS, Yang TH et al. The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. EuroIntervention 2012; 8: 501-510
    CrossrefGoogle Scholar
  • 25 Mehta SR, Jolly SS, Cairns J et al. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol 2012; 60: 2490-2499
    CrossrefGoogle Scholar
  • 26 Steg PG, James SK, Gersh BJ. 2012 ESC STEMI guidelines and reperfusion therapy: Evidence-based recommendations, ensuring optimal patient management. Heart 2013; 99: 1156-1157
    CrossrefGoogle Scholar
  • 27 Thiele H, Zeymer U, Neumann F-J et al. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. N Engl J Med 2012; 367: 1287-1296
    CrossrefGoogle Scholar
  • 28 Freimark D, Matetzky S, Leor J et al. Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis. Am J Cardiol 2002; 89: 381-385
    CrossrefGoogle Scholar
  • 29 OʼGara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e362-e425
    CrossrefGoogle Scholar
  • 30 Montalescot G, Wiviott SD, Braunwald E et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009; 373: 723-731
    CrossrefGoogle Scholar
  • 31 Steg PG, James S, Harrington RA et al. for the PLATO Study Group. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: A platelet inhibition and patient outcomes (PLATO) trial subgroup analysis. Circulation 2010; 122: 2131-2141
    CrossrefGoogle Scholar
  • 32 Dörler J, Edlinger M, Alber HF et al. Clopidogrel pre-treatment is associated with reduced in-hospital mortality in primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Eur Heart J 2011; 32: 2954-2961
    CrossrefGoogle Scholar
  • 33 Koul S, Smith JG, Schersten F et al. Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Eur Heart J 2011; 32: 2989-2997
    CrossrefGoogle Scholar
  • 34 Montalescot G, Lassen JF, Hamm CW et al. Ambulance or in-catheterization laboratory administration of ticagrelor for primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: rationale and design of the randomized, double-blind Administration of Ticagrelor in the cath Lab or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery (ATLANTIC) study. Am Heart J 2013; 165: 515-522
    CrossrefGoogle Scholar
  • 35 Mehilli J, Kastrati A, Schulz S et al. for the Bavarian Reperfusion Alternatives Evaluation-3 Study I. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: A randomized double-blind trial. Circulation 2009; 119: 1933-1940
    CrossrefGoogle Scholar
  • 36 vanʼt Hof AWJ, ten Berg J, Heestermans T et al. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. Lancet 2008; 372: 537-546
    CrossrefGoogle Scholar
  • 37 Stone GW, Witzenbichler B, Guagliumi G et al. Heparin plus a glycoprotein II b/III a inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicentre, randomised controlled trial. Lancet 2011; 377: 2193-2204
    CrossrefGoogle Scholar
  • 38 Montalescot G, Zeymer U, Silvain J et al. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet 2011; 378: 693-703
    CrossrefPubMedGoogle Scholar