Risikostratifizierung des NSTE-ACS

Zusammenfassung

Mit zunehmender Verbesserung der Prognose der NSTE-ACS-Patientenkollektive in den letzten Jahren spielt eine standardisierte, schnelle und gute diskriminierende Risikostratifizierung eine erhebliche Rolle. Verschiedene Merkmale des langfristig erwartbaren ischämischen Risikos, wie z.B. klinische Parameter, EKG-Indikatoren, Biomarker und klinische Scores, werden zusammen mit dem individuellen Blutungsrisiko erfasst und integriert. So ist z.B. die absolute Höhe der Troponin-Konzentration prädiktiv für die Gesamtletalität. Der GRACE-Risk-Score wird nicht nur zusätzlich zur objektiven Risikostratifizierung empfohlen, sondern ein Punktwert >140 ist eines der Kriterien für eine frühe Koronarangiografie innerhalb von 24 Stunden. Die Abschätzung des Blutungsrisikos entsprechend der ARC-HBR-Kriterien hat einen Einfluss auf das antithrombotische Therapieregime.

Abstract

With increasing improvement in prognosis of the majority of NSTE-ACS patients in recent years, standardized, fast and well discriminating risk stratification is gaining importance. Different characteristics of the long-term expected ischemic risk such as clinical parameters, ECG indicators, biomarkers, or clinical risk scores are recorded and integrated in coordination with the individual risk of bleeding. For example, the absolute level of troponin concentration is predictive for all-cause mortality. The GRACE risk score is not only recommended for additional objective risk stratification, but is also one of the parameters indicating the need for an early invasive angiography within 24 hours. The assessment of the bleeding risk according to ARC-HBR criteria has an impact on the anti-thrombotic therapy.

Was ist wichtig?

• Zur Risikostratifizierung sollten verschiedene Merkmale des ischämischen Risikos, wie z.B. klinische Parameter, EKG-Indikatoren, Biomarker und klinische Risiko-Scores, zusammen mit dem individuellen Blutungsrisiko erfasst und integriert werden.

• Die Leitlinien empfehlen den GRACE-Risk-Score zur objektiven Risikostratifizierung.

• Die Leitlinien empfehlen eine Koronarangiografie innerhalb von 24 Stunden, wenn u.a. der GRACE-Risk-Score >140 Punkte ist.

Schlüsselwörter

NSTE-ACS - akutes Koronarsyndrom - Risikostratifizierung - ischämisches Risiko - GRACE-Risk-Score

Keywords

NSTE-ACS - acute coronary syndrome - risk stratification - ischemic risk - GRACE risk score

Publication History

Article published online:
26 April 2021

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