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Kardiologie up2date 2016; 12(03): 291-305
DOI: 10.1055/s-0042-114640
Kardiovaskuläre Notfälle
© Georg Thieme Verlag KG Stuttgart · New York

Notfallrevaskularisation bei STEMI und kardiogenem Schock

Harald Lapp
,
Philipp Lauten
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Publication History

Publication Date:
29 September 2016 (online)

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Abstract

Treatment and outcome of ST-segment elevation infarction (STEMI) has been advancing with the development of pharmacologic agents and mechanical revascularization that have reduced mortality. In patients presenting STEMI, primary percutaneous coronary intervention (PPCI) is recommended reperfusion therapy. Access site is an important procedural aspect related to the successful of a PPCI. However, the clinical outcome of patients with STEMI complicated by cardiogenic shock (CS) remains unsatisfactory despite high rates of early revascularization. Conservative management with inotropes belongs furthermore to the initial therapie, but nowadays mechanical circulatory support devices become widely used for intensive treatment of patients with circulatory collapse refractory to conventional treatment. The percutaneous assist systems most commonly used in cardiogenic shock complicating an ST-elevation myocardial infarction are the intra-aortic ballon pump (IABP), the Impella pump, v-a ECMO and the Tandem Heart.

Kernaussagen

  • Die Prognose von Patienten mit ST-Strecken-Hebungsinfarkt hat sich in den vergangenen Jahren kontinuierlich verbessert. Entscheidend dafür sind die frühzeitige Diagnose, die Organisation der prä- und intrahospitalen Abläufe sowie die frühzeitige, komplette und anhaltende Reperfusion des Infarktgefäßes.

  • Die prozeduralen Abläufe und Strategien sowie die periinterventionelle Begleittherapie sind in großen kontrollierten Studien validiert und in Leitlinien eingearbeitet oder finden aktuell ihren Eingang in die Leitlinien.

  • Eine große medizinische Herausforderung bleiben die Patienten im kardiogenen Schock trotz erfolgreicher Reperfusion. Die genauen pathophysiologischen Abläufe sind im Detail nicht klar.

  • Es zeichnet sich zunehmend ab, dass mechanische Unterstützungssysteme einen Überlebensvorteil bieten können. Deren Einsatz ist teilweise komplex und benötigt eine hohe Expertise.

  • Aus unserer Sicht sollten sich lokal in Krankenhäusern Schock-Teams etablieren, die sich regional vernetzen, um die teils aufwendigen Behandlungsverfahren optimal einsetzen zu können.

 

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