Download PDF
Notfallmedizin up2date 2015; 10(04): 321-336
DOI: 10.1055/s-0041-109242
Spezielle Notfallmedizin
Georg Thieme Verlag KG Stuttgart · New York

Chest Pain Units

Julia Windolph
,
Ingo Eitel
,
Holger Thiele
Further Information

Publication History

Publication Date:
22 December 2015 (online)

Also available at
    Permissions and Reprints All articles of this category
Kernaussagen

  • Ziel von Chest Pain Units (CPU) ist es, schnell und sicher die Genese von thorakalen Beschwerden, inklusive der Patienten mit Verdacht auf ein akutes Koronarsyndrom (ACS), abzuklären, um eine schnelle und optimierte Therapie bei Patienten mit ACS/AMI (= akuter Myokardinfarkt) zu gewährleisten.

  • Das ACS setzt sich aus dem STEMI, NSTEMI und der instabilen Angina pectoris (AP) zusammen.

  • Ein Myokardinfarkt wird definiert durch eine Erhöhung der kardialen Troponine in Zusammenhang mit typischen pektanginösen Beschwerden und/oder infarkttypischen EKG-Veränderungen.

  • Kardiale Troponine können selbst geringe Myokardschäden mit hoher Sensitivität detektieren und haben somit höchste prognostische Aussagekraft und therapeutische Konsequenz im Rahmen eines ACS.

  • Neben dem EKG und kardialen Biomarkern (insbesondere Troponin) dienen diverse Risikoscores zur optimierten Risikostratifizierung eines ACS-Patienten.

  • Die Etablierung einer CPU mit optimierten diagnostischen und therapeutischen Prozessen dient nachhaltig einer Verkürzung des stationären Aufenthalts, der Reduktion der Kosten und hat in ersten Studien auch eine Reduktion der Mortalität gezeigt.

 

  • Quellenangaben

  • 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 Post E, Giannitsis E, Darius H et al. Kriterien der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung für „Chest Pain Units“. Kardiologe 2015; 9: 171-181
    CrossrefGoogle Scholar
  • 4 Akkerhuis KM, Klootwijk PA, Lindeboom W et al. Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J 2001; 22: 1997-2006
    CrossrefGoogle Scholar
  • 5 Hamm CW, Bassand JP, Agewall S et al. ESC guidelines for the management of acute coronary syndrome in patients presenting without persisting ST-Segment elevation: The Task Force for the Management of Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2999-3054
    CrossrefGoogle Scholar
  • 6 Siebens K, Moons P, De Geest S et al. The role of nurses in a chest pain unit. Eur J Cardiovasc Nurs 2007; 6: 265-272
    CrossrefGoogle Scholar
  • 7 Scholz KH, von Knobelsdorff G, Ahlersmann D. et al. Prozessentwicklung in der Herzinfarktversorgung. Herz 2008; 33: 102-109
    CrossrefGoogle Scholar
  • 8 Zahn R et al. Reperfusion therapy for acute ST-elevation and non ST-elevation myocardial infarction: what can be achieved in daily clinical practice in unselected patients at an interventional center?. Acute Cardiol Care 2009; 11: 92-98
    Google Scholar
  • 9 Bauer T et al. Efficacy of a 24-h primary percutaneous coronary intervention service on outcome in patients with ST elevation myocardial infarction in clinical practice. Clin Res Cardiol 2009; 98: 171-178
    CrossrefGoogle Scholar
  • 10 Dirschedl P, Lenz S, Löllgen H et al. Zur Validität der transtelephonischen EKG-Mehrkanal-Übertragung. Z Kardiol 1996; 85: 677-683
    Google Scholar
  • 11 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
  • 12 Universitätsklinikum Schleswig-Holstein - UKSH. „Door to balloon“. Zeiten bei akutem Myokardinfarkt.. Im Internet: http://www.uksh.de/innere2-luebeck/d2bt.html Stand: 21.11.2015
    Google Scholar
  • 13 Keller T, Post F, Tzikas S et al. Improved outcome in acute coronary syndrome by establishing a chest pain unit. Clin Res Cardiol 2010; 99: 149-155
    CrossrefGoogle Scholar
  • 14 Steg PG, James SK, Atar D et al. ESC guidelines for the management of acute myocardial infarction in patients presenting persisting with ST-Segment elevation. Eur Heart J 2012; 33: 2569-2619
    CrossrefPubMedGoogle Scholar
  • 15 Keller T, Zeller T, Peetz D et al. Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 2009; 361: 868-877
    CrossrefPubMedGoogle Scholar
  • 16 Kurz K, Giannitsis E, Becker M et al. Comparison of new high sensitive cardiac troponin T with myoglobin, h-FABP and cTNT for the early identification of myocardial necrosis in the acute coronary syndrome. Clin Res Cardiol 2011; 100: 209-215
    CrossrefGoogle Scholar
  • 17 Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60: 1581-1598
    CrossrefPubMedGoogle Scholar
  • 18 Mehta SR, Granger CB, Boden WE et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 2009; 360: 2165-2175
    CrossrefGoogle Scholar
  • 19 Wright RS, Anderson JL, Adams CD et al. ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 57: e215-e367
    Google Scholar
  • 20 Morrow DA, Cannon CP, Jesse RL et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation 2007; 115: e356-e375
    CrossrefGoogle Scholar
  • 21 Giannitsis E, Kurz K, Hallermayer K et al. Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 2010; 56: 254-261
    CrossrefGoogle Scholar
  • 22 Thygesen K, Mair J, Gianitsis E et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012; 33: 2252-2257
    CrossrefGoogle Scholar
  • 23 Jaffe AS, Ravkilde J, Roberts R et al. Itʼs time for a change to a troponin standard. Circulation 2000; 102: 1216-1220
    CrossrefGoogle Scholar
  • 24 Thygesen K, Alpert JS, White HD et al. Universal definition of myocardial infarction. Circulation 2007; 116: 2634-2653
    CrossrefPubMedGoogle Scholar
  • 25 Reichlin T, Hochholzer W, Bassetti S et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 2009; 361: 858-867
    CrossrefGoogle Scholar
  • 26 Reichlin T, Schindler C, Drexler B et al. One hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 2012; 172: 1211-1218
    CrossrefGoogle Scholar
  • 27 Cullen L, Mueller C, Parsonage WA et al. Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-days outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol 2013; 62: 1242-1249
    CrossrefGoogle Scholar
  • 28 Maisel A, Mueller C, Neath SX et al. Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial Infarction). J Am Coll Cardiol 2013; 62: 150-160
    CrossrefPubMedGoogle Scholar
  • 29 Mockel M, Searle J, Hamm C et al. Early discharge using single cardiac troponin and copeptin testing in patients with susupected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J 2015; 36: 369-376
    CrossrefGoogle Scholar
  • 30 Roffi M, Patrono C, Collet JP et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2015; DOI: 10.1093/eurheartj/ehv320.
    Google Scholar
  • 31 Jeremias A, Gibson CM. Narrative review: alternative causes for the elevated cardiac troponin levels when acute coronary syndromes are excluded. Ann Intern Med 2005; 142: 786-791
    CrossrefGoogle Scholar
  • 32 Ilva TJ, Eskola MJ, Nikus KC et al. The etiology and prognstic significance of cardiac troponin I elevation in unselected emergency department patients. J Emerg Med 2010; 38: 1-5
    CrossrefGoogle Scholar
  • 33 De Gennaro L, Brunetti ND, Cuculo A et al. Increased troponin levels in nonischaemic cardiac conditions and noncardiac diseases. J Interv Cardiol 2008; 21: 129-139
    CrossrefGoogle Scholar
  • 34 Hiratzka LF, Bakris GL, Beckman JA et al. ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Pactice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Stroke Association, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121: e266-e369
    CrossrefPubMedGoogle Scholar
  • 35 Torbicki A, Perrier A, Konstantinides S et al. Guidelines on the diagnosis and managment of acute pulmonary embolism: Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 2008; 29: 2276-2315
    CrossrefGoogle Scholar
  • 36 Okamatsu K, Takano M, Sakai S et al. Elevated troponin T levels and lesion characteristics in non-ST-elevation acute coronary syndromes. Circulation 2004; 109: 465-470
    CrossrefGoogle Scholar
  • 37 Antmann EM, Tanasijevic MJ, Thompson B et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335: 1342-1349
    CrossrefGoogle Scholar
  • 38 Alcalai R, Planer D, Calhaoglu A et al. Acut coronary syndrome vs nonspecific troponin elevation in the gerneral population. Circulation 2007; 113: 1958-1965
    Google Scholar
  • 39 Xu RY, Zhu XF, Yang Y et al. High sensitive cardiac troponin T. J Geriatr Cardiol 2013; 10: 102-109
    Google Scholar
  • 40 Anderson JL, Adams CD, Antman EM et al. ACC/AHA 2007 Guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 2007; 116: e148-304
    CrossrefGoogle Scholar
  • 41 Eagle KA, Lim MJ, Dabbous OH et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. GRACE Investigators. JAMA 2004; 291: 2727-2733
    CrossrefGoogle Scholar
  • 42 Bavry AA, Kumbhani DJ, Rassi AN et al. Benefit of early invasive therapy in acute coronary syndrome: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 2006; 48: 1319-1325
    CrossrefGoogle Scholar
  • 43 Tzikas S, Keller T, Post F et al. Patientenzufriedenheit beim akuten Koronarsyndrom. Verbesserung durch die Etablierung einer Chest-Pain-Unit. Herz 2010; 35: 403-409
    CrossrefGoogle Scholar
  • 44 Farkouh ME, Smars PA, Reeder GS et al. A clinical trial of a chest pain observation unit for patients with unstable angina. N Engl J Med 1998; 339: 1882-1888
    CrossrefGoogle Scholar
  • 45 ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: Executive summary. Circulation 2007; 116: 803-807
    CrossrefGoogle Scholar
  • 46 Asher E, Haim R, Nir S et al. Clinical outcomes and cost effectiveness of accelerated diagnsostic protocol in a chest pain center compared with routine care of patients with chest pain. Plos One 2015; 10: e0117287
    CrossrefGoogle Scholar
  • 47 Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. – DGK. Chest Pain Unit.. Im Internet: http://cpu.dgk.org Stand: 26.08.2015
    Google Scholar
  • 48 Post F, Giannitsis E, Riemer T et al. Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the “German chest pain unit registry”. Clin Res Cardiol 2012; 101: 983-991
    CrossrefGoogle Scholar