Aggressiv und früh interventionell therapieren - Akutes Koronarsyndrom und Diabetes mellitus - eine Hochrisikokonstellation

Zusammenfassung

Der Diabetes mellitus zählt zu den Hauptrisikofaktoren für die Entstehung einer Mikro- oder Makroangiopathie. Nicht selten ist ein akutes Koronarsyndrom die erste klinische Manifestation der koronaren Herzkrankheit - aber auch des zuvor noch nicht diagnostizierten Diabetes mellitus. Zudem haben diabetische Patienten mit akutem Koronarsyndrom eine signifikant schlechtere Prognose. Mit den verschiedenen Thrombozytenaggregationshemmern (Acetylsalicylsäure, Clopidogrel, GP-IIb/IIIa-Rezeptorantagonisten) und der frühen invasiven Therapie mit PTCA und Stent stehen heute effektive Therapieoptionen zur Verfügung, von denen Diabetiker noch stärker profitieren als Nichtdiabetiker. Die medikamentöse Nachbehandlung akuter Koronarsyndrome entspricht den klassischen Therapieempfehlungen und setzt sich aus einer effizienten Thrombozytenaggregationshemmung (ASS plus Clopidogrel über mindestens neun Monate), Betablockern, ACE-Hemmern bzw. AT1-Blockern und Statinen zusammen. Bei Diabetikern und Patienten mit einer gestörten Glukosetoleranz ist zudem die Verabreichung von Acarbose eine interessante Therapieoption im Rahmen der Blutzuckernormalisierung, da diese Substanz laut aktuellen Studien ein kardioprotektives Potenzial zu besitzen scheint.

Summary

Diabetes mellitus is one of the major risk factors for the development of micro- or macroangiopathy. Not infrequently, an acute coronary syndrome is the first clinical manifestation of coronary heart disease - but also of an as yet undiagnosed diabetes mellitus. In addition, diabetic patients with an acute coronary syndrome have a significantly poorer prognosis. With the various platelet aggregation inhibitors (acetyl salicylic acid, clopidogrel, GP-IIb/IIa receptor antagonists) and early invasive treatment with PTCA and stenting, effective therapeutic options are now available, from which diabetics profit more than non-diabetics. Medicational follow-up treatment of the acute coronary syndrome meets the classical recommendations for treatment and comprises effective platelet aggregation inhibition (ASA plus clopidogrel for at least nine months), beta blockers, ACE inhibitors or AT1 blockers and statins. Furthermore, in the case of diabetics and patients with disturbed glucose tolerance, acarbose is an interesting therapeutic option for blood sugar normalisation, since current studies show that this substance has cardioprotective potential.

Key Words

acute coronary syndrome - diabetes mellitus type 2 - creatine kinase - Troponin - platelet aggregation inhibition - PTCA - stents - acarbose

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1 maximale individuelle Therapie beim akuten Myokardinfarkt

2 akutes Coronar-Syndrom

3 clopidogrel in unstable angina to prevent recurrent events

4 CURE-Substudie mit interventionell vorbehandelten Patienten

5 clopidogrel for reduction of events during observation

6 fragmin during instability in coronary artery disease

7 treat angina with aggrastat and determine cost of therapy with an invasive or conservative strategy

8 do tirofiban and reopro give similiar efficacy outcomes trial

9 west of scotland coronary prevention study

10 heart outcomes prevention evaluation

11 losartan intervention for endpoint reduction in hypertension

12 study to prevent non insulin dependent diabetes mellitus

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