Instabile Angina pectoris

Zusammenfassung

In den letzten Jahren wurden bei der instabilen Angina pectoris sowohl im Bereich des pathophysiologischen Verständnisses, der Risikostratifizierung als auch der Therapie große Fortschritte unternommen. Nebst besserer klinischer Risikostratifizierung stehen uns heute ebenfalls biochemische Marker wie z.B. das Troponin zur initialen Risikoabschätzung zur Verfügung. Zusätzlich zur Standardtherapie mit Azetylsalizylsäure und der intravenösen Vollheparinisierung verfügen wir über neuere Medikamente wie die niedermolekularen Heparine sowie die GPIIb/IIIa-Rezeptorantagonisten, welche in größeren Studien mit oder ohne koronare Intervention ihre Wirksamkeit bewiesen haben, vorerst jedoch vor allem den Hochrisikopatienten vorbehalten sein sollten. Die interventionelle Therapie wurde insbesondere durch die Entwicklung von koronaren Stents verbessert, die Wahl des richtigen Zeitpunkts der Intervention bleibt jedoch kontrovers.

Summary

Over recent years many advances have been realized in the pathophysiological understanding, risk stratification and treatment of unstable angina pectoris. Besides better clinical risk stratification biochemical markers such as Troponin are used today, which allow a better individual risk evaluation. New therapeutic agents like low molecular heparins and Platelet glycoprotein IIb/IIIa antagonists have been added to standard therapy with aspirin and intravenous heparin and have prooven their efficacy in major clinical trials with or without coronary intervention. Only high risk patients however should be treated with these agents at the moment. Interventional therapy has been improved especially with the introduction of coronary stents. The timing of coronary intervention in unstable angina, however, remains controversial.

Schlüsselwörter

Troponin - GPIIb/IIIa-Rezeptorantagonisten - niedermolekulares Heparin - PTCA/Stentimplantation

Keywords

Troponin - platelet glycoprotein IIb/IIIa antagonists - low molecular weight heparin - PTCA/stent-implantation

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