Moderne Therapie des akuten Koronarsyndroms

Zusammenenfassung

Unter dem Begriff „Akutes Koronarsyndrom“ (ACS) werden die Phasen der koronaren Herzerkrankung (KHK) zusammengefasst, die unmittelbar lebensbedrohlich sind. Beim ST-Hebungsinfarkt (STEMI) ist eine umgehende Reperfusionstherapie notwendig. Der Goldstandard ist hier die primäre perkutane Koronarintervention (PCI). Beim ACS ohne ST-Streckenhebung (NSTE-ACS) sollte bei Patienten mit Risikomerkmalen innerhalb von 72 Stunden eine Koronarangiographie durchgeführt werden. Je nach Koronarbefund wird der Patient mittels PCI, aorto-koronarer Bypasschirurgie oder rein medikamentös behandelt. Der antithrombozytären Therapie kommt beim ACS eine Schüsselrolle zu. Zusätzlich zur Acetylsalicylsäure (ASS) ist die Gabe eines weiteren Thrombozytenaggregationshemmers für 12 Monate indiziert. Für die Mehrheit der Patienten sind Ticagrelor und Prasugrel die Substanzen der ersten Wahl, da beide schneller und stärker wirken als Clopidogrel. Bei Patienten mit hohem Blutungsrisiko bleibt Clopidogrel aber der zu bevorzugende Plättchenhemmer. Neben der antithrombozytären Therapie ist beim ACS zudem eine antikoagulatorische Therapie notwendig.

Abstract

The „acute coronary syndrome“ (ACS) is a life threatening condition. In patients with ST-segment elevation myocardial infarction (STEMI) an immediate reperfusion therapy is indicated. Primary percutaneous coronary intervention (PCI) is the gold standard. In ACS without ST-segment elevation (NSTE-ACS) coronary angiography should be performed within 72 hours in patients with risk factors. Depending on the coronary anatomy treatment options are PCI, aorto-coronary bypass surgery or sole medical therapy. The antiplatelet therapy has a key role in ACS. In addition to acetylsalicylic acid (ASA) another platelet aggregation inhibitor should be given for 12 months. For the majority of patients ticagrelor and prasugrel are the agents of first choice, because both act faster and stronger than clopidogrel. In patients at high risk of bleeding clopidogrel remains the preferable antiplatelet agent. In addition to antiplatelet treatment anticoagulant therapy is necessary in ACS-patients.

Schlüsselwörter

Akutes Koronarsyndrom - perkutane Koronarintervention - Acetylsalicylsäure - Clopidogrel - Ticagrelor - Prasugrel - Antikoagulation

Keywords

acute coronary syndrome - PCI - acetyl salicylic acid - clopidogrel - ticagrelor - prasugrel - anticoagulation

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