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DOI: 10.1055/a-1180-8021
Risikostratifizierung des chronischen Koronarsyndroms – Empfehlungen zur Risikobewertung und Diagnostik im klinischen Alltag gemäß ESC-Leitlinie 2019
Risk Stratification of CCS – Recommendations for Risk Assessment and Diagnostics in Clinical Practice According to ESC Guideline 2019Publication History
Publication Date:
30 June 2020 (online)
Zusammenfassung
Die neue Leitlinie der European Society of Cardiology (ESC) von 2019 liefert neue Empfehlungen zum Umgang mit dem chronischen Koronarsyndrom (CCS, früher stabile koronare Herzerkrankung = KHK). In diesem Beitrag werden Methoden zur Bestimmung der Prätestwahrscheinlichkeit eines CCS und die relevanten diagnostischen Mittel vorgestellt, wie etwa die neuen Empfehlungen für die Stellung des Angio-CT und die Verwendung der Koronarangiografie. Ein besonderer Schwerpunkt dieses Beitrags liegt auf denjenigen Patientengruppen, die Ärzte und Pflegekräfte im klinischen Alltag vor besondere Herausforderungen stellen. Hierzu gehören Patienten mit atypischer oder fehlender Klinik, Patienten höheren Alters und Patientinnen. Für diese Gruppen werden gesonderte Empfehlungen formuliert.
Abstract
The 2019 ESC (European Society of Cardiology) Guidelines include new recommendations for the diagnosis and management of chronic coronary syndromes (CCS). In this article, we present a model to estimate the pre-test probability of CCS and relevant diagnostic tools, such as using coronary CTA and invasive coronary angiography. The ESC guidelines focus particularly on those patient groups that require specific diagnosis and management. Here, we summarize the recommendations for asymptomatic patients, the elderly, and women.
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Der neue Begriff des chronischen Koronarsyndroms, der den alten Begriff der chronischen koronaren Herzerkrankung abgelöst hat, definiert den in den meisten Fällen unaufhaltsamen Progress dieser Krankheit mit der Notwendigkeit lebenslanger, intensiver Therapie.
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In der Diagnostik hat das Belastungs-EKG zu Gunsten anderer Verfahren wie der CT-Angiografie an Bedeutung verloren
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Besondere Aufmerksamkeit bzgl. Diagnostik und Therapie erfordert die Behandlung von Patienten mit Diabetes mellitus, alten Patienten (> 75 Lebensjahre) und insbesondere auch Frauen, u. a. da in diesen Gruppen häufig atypische Symptome vorliegen.
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Literatur
- 1 Knuuti J, Wijns W, Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 2020; 41: 407-477 doi:10.1093/eurheartj/ehz425
- 2 Dürschmied D, Bode C, von zur Mühlen C. Chronisches Koronarsyndrom: Neudefinition der „stabilen“ koronaren Herzerkrankung. Dtsch Arztebl 2019; 116 (Suppl. 40) 12-16 doi:10.3238/PersKardio.2019.10.04.02
- 3 Bundesärztekammer (BÄK); Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Chronische KHK – Langfassung. 5. Aufl. Version 1; 2019. Im Internet (Stand: 15.05.2020): http://www.khk.versorgungsleitlinien.de
- 4 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: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267-315
- 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 in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-177
- 6 Diamond GA, Forrester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med 1979; 300: 1350-1358
- 7 CAD consortium. Pre-test probability of CAD (CAD consortium). Im Internet (Stand: 15.05.2020): https://qxmd.com/calculate/calculator_287/pre-test-probability-of-cad-cad-consortium
- 8 Tonino PA, Fearon WF, De Bruyne B. et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 2010; 55: 2816-2821
- 9 Knuuti J, Ballo H, Juarez-Orozco LE. et al. The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability. Eur Heart J 2018; 39: 3322-3330
- 10 Collet C, Onuma Y, Andreini D. et al. Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease. Eur Heart J 2018; 39: 3689-3698
- 11 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
- 12 Di Angelantonio E, Danesh J, Eiriksdottir G. et al. Renal function and risk of coronary heart disease in general populations: new prospective study and systematic review. PLoS Med 2007; 4: e270
- 13 Silverman MG, Ference BA, Im K. et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA 2016; 316: 1289-1297
- 14 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315-2381
- 15 Zacharias K, Ahmed A, Shah BN. et al. Relative clinical and economic impact of exercise echocardiography vs. exercise electrocardiography, as first line investigation in patients without known coronary artery disease and new stable angina: a randomized prospective study. Eur Heart J Cardiovasc Imaging 2017; 18: 195-202
- 16 Malkin CJ, Prakash R, Chew DP. The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2012; 2: e000540
- 17 Kim ES, Carrigan TP, Menon V. Enrollment of women in National Heart, Lung, and Blood Institute-funded cardiovascular randomized controlled trials fails to meet current federal mandates for inclusion. J Am Coll Cardiol 2008; 52: 672-673
- 18 Khan NA, Daskalopoulou SS, Karp I. et al. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med 2013; 173: 1863-1871
- 19 Davis M, Diamond J, Montgomery D. et al. Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes. Clin Res Cardiol 2015; 104: 648-655
- 20 Cantor WJ, Mehta SR, Yuan F. et al. Radial versus femoral access for elderly patients with acute coronary syndrome undergoing coronary angiography and intervention: insights from the RIVAL trial. Am Heart J 2015; 170: 880-886
- 21 Varenne O, Cook S, Sideris G. et al. Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial. Lancet 2018; 391: 41-50
- 22 Filardo G, Hamman BL, Pollock BD. et al. Excess short-term mortality in women after isolated coronary artery bypass graft surgery. Open Heart 2016; 3: e000386