Akuter Myokardinfarkt bei Patienten mit Diabetes mellitus

Zusammenfassung

Kardiovaskuläre Erkrankungen stellen bei Patienten mit Diabetes mellitus die wesentliche Ursache für Morbidität und Mortalität dar. Haupttodesursache bei Diabetikern ist der akute Myokardinfarkt. Auch nach diesem Ereignis bestehen erhöhte Mortalitätsraten und eine höhere Inzidenz für die Entwicklung einer Herzinsuffizienz versus Patienten ohne Diabetes.

Pathophysiologische Besonderheiten ergeben sich im Hinblick auf die Auswirkung des Diabetes auf die koronare Herzerkrankung mit einer myokardialen und einer vaskulären Komponente. Darüber hinaus bestehen bei Diabetikern häufig weitere Erkrankungen wie die arterielle Hypertonie, Veränderungen der Hämostase, der Fibrinolyse, korpuskulärer Blutbestandteile und der Inflammation. Nicht alle klassischen diagnostischen Kriterien des Myokardinfarkts können bei Diabetikern aufgrund der Begleiterkrankungen uneingeschränkt angewandt werden. Die Therapie hat die rasche und permanente Reperfusion der verschlossenen Koronararterie zum Ziel; dabei kommen verschiedene pharmakologische Thrombolyse-Regime und die perkutane transluminale Koronarangioplastie in Frage. Weitere Studien müssen abgewartet werden, um ein optimales Vorgehen zur Prognoseverbesserung dieser Patientenpopulation zu finden.

Summary

The main cause for morbidity and mortality in patients with diabetes mellitus are cardiovascular diseases. Acute myocardial infarction in this group has a poorer outcome (death and development of heart failure) versus patients without diabetes. Preexisting myocardial, vascular, prothrombotic, antifibrinolytic alterations as well as an inflammatory state occur frequently in diabetic patients. Classical symptoms of acute myocardial infarction are often not present in patients with diabetes making the diagnosis more difficult. The aim of the therapy is to restore a prompt and permanent blood flow in the occluded coronary artery in order to preserve as much viable myocardium as possible. Different thrombolytic regimen are used nowadays, another option is the percutaneous coronary angioplasty. Further prospective studies are required to define optimal therapeutic strategies in this high risk population.

Schlüsselwörter

Diabetes mellitus - akuter Myokardinfarkt

Keywords

Diabetes mellitus - acute myocardial infarction

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