Revaskularisation und periinterventionelle Therapie im infarktbedingten kardiogenen Schock

Abstract

Early revascularization with percutaneous coronary intervention or coronary artery bypass grafting has been proven as beneficial for survival in patients with myocardial infarction complicated by cardiogenic shock. This review focuses on technical aspects of coronary revascularization and additive medication. One of the most important actual questions in intervention in cardiogenic shock is the decision to perform culprit lesion only or multi-vessel percutaneous coronary intervention in patients with multivessel coronary artery disease. A large randomized study is currently enrolling patients to answer this question.

Kernaussagen

• Der kardiogene Schock ist die für die Prognose bedeutsamste Komplikation des akuten Myokardinfarkts.

• Aktuell ist nur die möglichst schnelle Revaskularisation eine validierte Therapie mit positivem Effekt auf das Überleben.

• Meist ist eine Revaskularisation durch eine primäre PCI möglich, bei komplexer, für eine PCI nicht geeigneter Anatomie kann nach Rücksprache im Heart-Team auch eine sofortige CABG in Erwägung gezogen werden.

• Der Frage, ob nur die akute Infarktläsion oder bei Mehrgefäßerkrankung auch andere Stenosen behandelt werden soll, wird gerade in einer großen multizentrischen Studie nachgegangen.

• Eine Thrombolyse sollte nur bei Patienten durchgeführt werden, für die eine PCI nicht innerhalb einer adäquaten Zeit erreicht werden kann. Aufgrund der Infrastruktur in Deutschland sollten diese Fälle aber faktisch nicht vorkommen.

• Die adjunktive Begleitmedikation zur Revaskularisation sollte aufgrund fehlender Daten für den kardiogenen Schock gemäß den Empfehlungen für den akuten Myokardinfarkt gegeben werden.

• Literatur

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