Risikostratifizierung beim akuten Koronarsyndrom

Zusammenfassung

Die Risikostratifizierung bei Patienten mit akutem Koronarsyndrom erlaubt vor allem die Festlegung der frühen Behandlungsstrategie und der Intensität der medikamentösen Begleittherapie. Dabei werden die Risikopatienten identifiziert, die von einer frühen Koronarintervention und einer Begleittherapie mit Glykoprotein-IIb/IIIa-Rezeptorantagonisten (GPIIb/IIIa-Antagonisten) profitieren. Diabetiker mit akutem Koronarsyndrom sind ein besonderes Patientenkollektiv, da sie einerseits eine schlechte Prognose für das frühe Auftreten von Tod und Herzinfarkt haben und andererseits suboptimal behandelt werden. Schon eine gestörte Glukosetoleranz und eine akute Stresshyperglykämie verschlechtern die Prognose. Bei vielen Patienten mit akutem Koronarsyndrom wird ein Diabetes mellitus erstmalig diagnostiziert. Diabetiker profitieren besonders von einer frühen Koronarintervention und einer frühen Begleittherapie mit GPIIb/IIIa-Antagonisten. Häufig verhindert aber eine verspätete Sicherung der Diagnose eine frühe und effektive Therapie.

Summary

The main significance of risk stratification for patients with the acute coronary syndrome (ACS) lies in the early provision of a treatment strategy and of the right dosage of associated drugs. It identifies patients who will benefit from early coronary intervention together with administration of glycoprotein IIb/IIIa receptor inhibitors (GRI). Diabetics with ACS constitute a special group with a poor prognosis regarding early death or myocardial infarction and yet they receive suboptimal treatment. Even impaired glucose tolerance and acute stress hyperglycemia worsen their prognosis. In many patients with ACS diabetes is diagnosed for the first time. Especially diabetics profit from early coronary intervention and early additional administration of GRI: yet any delay in confirming the diagnosis frequently prevents early and efficacious treatment.

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