Der Patient mit akutem Koronarsyndrom und Diabetes mellitus

Patienten mit Typ-2-Diabetes haben nicht nur ein besonders hohes kardiovaskuläres Risiko - Myokardinfarkte, Herzinsuffizienzen oder Schlaganfälle sind die führenden Todesursachen bei dieser Patientengruppe - im Vergleich zu Stoffwechselgesunden weist eine koronare Herzerkrankung bei diesen Patienten epidemiologische, pathophysiologische, prognostische und klinische Besonderheiten auf. Oft ist ein akutes Koronarsyndrom nicht nur die erste klinische Manifestation der koronaren Herzkrankheit, sondern auch des zuvor noch nicht diagnostizierten Diabetes. Umso bedauerlicher ist es, dass bei einem Großteil der Patienten mit akutem Koronarsyndrom ein möglicherweise bestehender Diabetes mellitus bei der Einweisung in die Klinik nicht konsequent diagnostiziert wird und damit unerkannt bleibt. Gerade vor dem Hintergrund, dass hohe Glukosewerte deutlich prognoserelevant sind, sind ein konsequentes Diabetesscreening von ACS-Patienten, häufige Blutglukosemessungen und eine aufgrund des hohen kardiovaskulären Risikos der Betroffenen aggressive Diagnose (EKG, hoch sensitive Troponinassays) und Behandlung (Revaskularisierung, antithrombotische Therapie) auch bezüglich der vaskulären Risikofaktoren und Gefäßmanifestationen (z. B. Statine, Betablocker) angezeigt.

Cardiovascular risk is particularly high for patients with type 2 diabetes; the major causes of death in these patients include myocardial infraction, heart failure and stroke. What is more, coronary heart disease in these patients exhibits special epidemiological, pathophysiological, prognostic and clinical features in comparison to individuals with healthy metabolism. It is often the case that acute coronary syndrome is not only the first clinical manifestation of coronary heart disease, but also of the previously undiagnosed diabetes. This makes it even more regrettable that consistent diagnostic testing for diabetes mellitus is not performed on many ACS patients on admission to hospital, so that their diabetes is not detected. If it is born in mind that high glucose values are clearly relevant to the prognosis, ACS patients must be consistently screened for diabetes. Frequent blood glucose measurements must be carried out. Because of the high cardiovascular risk, aggressive diagnostic testing (EKG, highly sensitive troponin assays) and treatment (revascularisation, antithrombotic therapy) must be implemented, bearing in mind the vascular risk factors and manifestations (e. g. statins, beta-blockers).

Key words

acute coronary syndrome - diabetes mellitus - vascular risk factors - troponin - revascularisation - antithrombotic therapy

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