Zusammenfassung
Der akute Thoraxschmerz gehört zu den häufigsten Leitsymptomen im notärztlichen Rettungsdienst. Initiale Aufgabe des Notarztes ist es, einen Myokardinfarkt mit ST-Streckenhebung bereits präklinisch aus dem 12-Kanal-EKG zu diagnostizieren. Bei diesen Patienten müssen unverzüglich Reperfusionsmaßnahmen eingeleitet werden. Zahlreiche Studien haben gezeigt, dass die Reperfusion durch Katheterbehandlung der Fibrinolyse überlegen ist. Durch Transport des Patienten in ein Zentrum mit Katheterbereitschaft kann der Notarzt so entscheidende Weichen für eine effiziente Infarktbehandlung stellen. Die Katheterbehandlung ist auch dann der Fibrinolyse vor Ort überlegen, wenn sie einen erheblich längeren Transportweg bedingt. Die prähospitale Lyse ist mit Risiken verbunden, ohne dass ihr Nutzen im Rahmen der katheterbasierten Behandlungsstrategie gesichert wäre. Auch Therapiemaßnahmen wie die antithrombotische Therapie, inklusive der GP-IIb-IIIa-Rezeptorantagonisten und Thienopyridine sowie der Einsatz der β-Blocker und Analgetika werden anhand evidenzbasierter Kriterien besprochen.
Abstract
Acute chest pain is one of the most frequent symptoms presenting to rescue service. Initial goal of the emergency physician is to diagnose myocardial infarction with ST-elevation preclinically with the use of a 12-lead-ECG. In these patients myocardial reperfusion strategies have to be instituted without delay. Numerous studies have shown that reperfusion by catheter intervention is superior to fibrinolysis. By transporting the patient to a centre with catheterisation facilities the emergency physician can set the stage for the most efficient treatment of myocardial infarction. Catheter intervention in acute myocardial infarction is superior to fibrinolysis even if this increases the distance for transport substantially. Prehospital thrombolysis is associated with risks without having shown benefit as part of a catheter-based reperfusion strategy. Other management strategies like therapy with antithrombotics - including GP IIb-IIIa receptor blockers or thienopyridines - analgetics and β-blockers will be discussed according to evidence-based criteria.
Schlüsselwörter
Akutes Koronarsyndrom - Myokardinfarkt - präklinische Therapie - Fibrinolyse - PTCA
Key words
Acute coronary syndrome - myocardial infarction - prehospital care - fibrinolysis - PCI
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