Subscribe to RSS
DOI: 10.1055/s-2006-956264
© Georg Thieme Verlag KG Stuttgart · New York
Pathogenese und Therapie des akuten Koronarsyndroms differenzieller Nutzen von GPIIb/IIIa-Rezeptorantagonisten bei Hochrisikopatienten
Pathogenesis and therapy of the acute coronary syndrome: differentiated advantage of glycoprotein IIb/IIIa receptor antagonists for high-risk patientsPublication History
eingereicht: 14.6.2006
akzeptiert: 20.7.2006
Publication Date:
15 November 2006 (online)

Zusammenfassung
Für die Pathophysiologie des akuten Koronarsyndroms spielen aktivierte Thrombozyten und deren Aggregation zu einem Thrombus eine entscheidende Rolle. Glykoprotein-IIb/IIIa-Rezeptorantagonisten (GPIIb/IIIa-Rezeptorantagonisten) blockieren die Bindung von Fibrinogen an GPIIb/IIIa-Rezeptoren aktivierter Thrombozyten und verhindern deren Aggregation. Patienten mit akutem Koronarsyndrom und erhöhten Troponin-Werten, die einer primären Revaskularisierung unterzogen werden sollen, haben einen besonderen Nutzen von einer Behandlung mit GPIIb/IIIa-Rezeptorantagonisten. Dies gilt auch und insbesondere für Diabetiker.
Summary
Pathogenesis and therapy of the acute coronary syndrome: differentiated advantage
of glycoprotein IIb/IIIa receptor antagonists for high-risk patients
Activated thrombocytes and their aggregation into a thrombus play a decisive role
in the pathogenesis of the acute coronary syndrome. Glycoprotein (GP) IIb/IIIa receptor
antagonists block the binding of fibrinogen to GP IIb/IIIa receptors of activated
thrombocytes and inhibit their aggregation. Patients with an acute coronary syndrome
and raised troponin levels who are to undergo primary coronary revascularization profit
particularly from treatment with GPIIb/IIIa receptor antagonists. This is especially
so if they also have diabetes.
Literatur
- 1
Abrahamian H.
Aggregationsneigung beim Diabetes mellitus.
Acta Med Austriaca.
1999;
5
137-141
MissingFormLabel
- 2
Arjomand H, Roukoz B. et al .
Platelets and antiplatelet therapy in patients with diabetes mellitus.
J Invas Cardiol.
2003;
15
264-269
MissingFormLabel
- 3
Benamer H, Steg P G, Benessiano J. et al .
Elevated cardiac troponin I predicts a high-risk angiographic anatomy of the culprit
lesion in unstable angina.
Am Heart J.
1999;
137
815-820
MissingFormLabel
- 4
Bollinger C, Schwenk B, Leschke M.
Akutes Koronarsyndrom und Diabetes mellitus - eine Hochrisikokonstellation.
Klinikarzt.
2004;
33
193-297
MissingFormLabel
- 5
Cannon C P, Weintraub W S, Demopoulos L A. et al .
Comparison of early invasive and conservative strategies in patients with unstable
coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban.
N Engl J Med.
2001;
344
1879-1887
MissingFormLabel
- 6
Chan A, Molitero D J. et al .
Triple antiplatelet therapy during percutaneous coronary intervention is associated
with improved outcomes including one-year survival.
J Am Coll Cardiol.
2003;
42
1188-1195
MissingFormLabel
- 7
Chertow G M. et al .
Survival after acute myocardial infarction in patients with end-stage renal disease.
Am Kidney Dis.
2000;
35
1044-1051
MissingFormLabel
- 8
Erbel R, Heusch G.
Coronary microembolization.
J Am Coll Cardiol.
2000;
36
22-24
MissingFormLabel
- 9
Falk E.
Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction
and/or sudden death.
Circulation.
1985;
71
699-708
MissingFormLabel
- 10
Fernandez J S, Sadaniantz B, Sadaniantz A.
Review of antithrombotic agents used for acute coronary syndromes in renal patients.
Am J Kidney Dis.
2003;
42
446-455
MissingFormLabel
- 11
Freeman R V, Mehta R H, Al Badr W. et al .
Influence of concurrent renal dysfunction on outcomes of patients with acute coronary
syndromes and implications of the use of glycoprotein IIb/IIIa inhibitors.
J Am Coll Cardiol.
2003;
41
718-724
MissingFormLabel
- 12
Heeschen C, von der Brand M J, Hamm C W, Simoons M L. for the CAPTURE investigators .
Angiographic findings in patients with refractory unstable angina according troponin
T status.
Circulation.
1999;
1000
1509-1514
MissingFormLabel
- 13
Herzog C A, Ma J Z, Collins A J.
Poor long-term survival after acute myocardial infarction among patients on long-term
dialysis.
N Engl J Med.
1998;
339
799-805
MissingFormLabel
- 14
Januzzi J L, Snapinn S M, Dibattiste P M. et al .
Benefits and safety of tirofiban among acute coronary syndrome patients with mild
to moderate renal insufficiency. Results from the PRISM-PLUS trial.
Circulation.
2002;
105
2361-2366
MissingFormLabel
- 15
Kastrati A, Mehilli J, Neumann F J. et al .
Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary
intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial.
JAMA.
2006;
295
1531-1538
MissingFormLabel
- 16 Meinertz J, Rösen P, Schömig A, Tschöpe D, Ziegler D. (Hrsg.). Diabetes und Herz. 1. Auflage, Steinkopff 2004
MissingFormLabel
- 17 Fachinformation Aggrastat® 250 Mikrogramm/ml. MSD Sharp & Dohme GmbH 2004
MissingFormLabel
- 18
Morrow D A, Cannon C P, Rifai A. et al .
Ability of minor elevations of troponins I and T to predict benefit from an early
invasive strategy in patients with unstable angina and non-ST elevation myocardial
infarction.
JAMA.
2001;
286
2405-2412
MissingFormLabel
- 19
Münzel T, Daiber A, Ullrich V, Mulsch A.
Vascular consequences of endothelial nitric oxide synthase uncoupling for the activity
and expression of the soluble guanylyl cyclase and the cGMP-dependent protein kinase.
Arterioscler Thromb Vasc Biol.
2005;
25
1551-1557
MissingFormLabel
- 20
O’Hanlon R, Reddan D N.
Treatment of acute coronary syndromes in patients who have chronic kidney disease.
Med Clin N Am.
2005;
89
563-585
MissingFormLabel
- 21
Osende J I, Badimon J J, Fuster V. et al .
Blood thrombogenicity in type 2 diabetes mellitus is associated with glycemic control.
J Am Coll Cadiol.
2001;
38
1307-1312
MissingFormLabel
- 22
Roffi M, Chew D P. et al .
Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with
non-ST-segment-elevation acute coronary syndromes.
Circulation.
2001;
104
2767-2771
MissingFormLabel
- 23
Roffi M, Moliterno D J, Meier B. et al. for the TARGET investigators .
Impact of different platelet glycoprotein IIb/IIIa inhibitors among diabetic patients
undergoing percutaneous coronary intervention. Do Tirofiban or ReoPro Give Similar
Efficacy Outcomes Trial (TARGET) 1-year-follow-up.
Circulation.
2002;
105
2730-2736
MissingFormLabel
- 24
Schneider D J, Keating F K, Baumann P Q. et al .
Increased ability of tirofiban to maintain its inhibitory effects on the binding of
fibrinogen to platelets in blood from patients with and without diabetes mellitus.
Coron Artery Dis.
2006;
17
57-61
MissingFormLabel
- 25
Shrape P C, Trinick T.
Mean platelet volume in diabetes mellitus.
Q J Med.
1993;
86
739-742
MissingFormLabel
- 26
Smith B S, Gandhi P J.
Pharmacocinetics and pharmacodynamics of low-molecular-weight heparins and glycoprotein
IIb/IIIa receptor agonists in renal failure.
J Thromb Thrombolysis.
2001;
11
39-48
MissingFormLabel
- 27
Sreedhara R, Itagaki I, Hakim R M.
Uremic patients have decrease shear-induced platelet aggregation mediated by a decreased
availability of glycoprotein IIb/IIIa receptors.
Am J Kidney Dis.
1996;
27
355-364
MissingFormLabel
- 28
Terres W. et al .
Enhanced coagulation activation in troponin T-positive unstable angina pectoris.
Am Heart J.
1998;
135
281-286
MissingFormLabel
- 29
The PRISM-PLUS Study Investigators .
Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable
angina and non-Q-wave-myocardial infarction.
N Engl J Med.
1998;
338
1488-1497
MissingFormLabel
- 30
The PRISM Study Investigators .
A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina.
N Engl J Med.
1998;
338
1498-1505
MissingFormLabel
- 31
Tschoepe D, Rauch U, Schwippert B.
Platelet-leucocyte-cross-talk in diabetes mellitus.
Horm Metab Res.
1997;
29
631-635
MissingFormLabel
- 32
Tschoepe D, Roesen P, Kaufmann L. et al .
Evidence for abnormal platelet glycoprotein expression in diabetes mellitus.
Eur J Clin Invest.
1990;
20
166-170
MissingFormLabel
- 33
Valgimigli M, Campo G, Percoco G. et al .
Tirofiban: a critical reappraisal of the clinical use, recent developments and future
perspectives.
Future Cardiol.
2006;
2
17-27
MissingFormLabel
- 34
International, randomized, controlled trial of lamifiban (a platelet glycoprotein
IIb/IIIa inhibitor), heparin or both in unstable angina. The PARAGON Investigators .
Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in
a Global Organization Network.
Circulation.
1998;
97
2386-2395
MissingFormLabel
- 35
Moliterno DJ.
Patient-specific dosing of IIb/IIIa antagonists during acute coronary syndromes: rationale
and design of the PARAGON B study.
Am Heart J..
2000;
139
563-566
MissingFormLabel
- 36
Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute
coronary syndromes. The PURSUIT Trial Investigators .
Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Supression Using Integrilin
Therapy.
N Engl J Med.
1998;
339
436-443
MissingFormLabel
- 37
Simoons ML.
Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients
with acute coronary syndromes without early coronary revascularisation: the GUSTO
IV-ACS randomized trial.
Lancet.
2001;
357
1915-1924
MissingFormLabel
Prof. Dr. med. Thomas Münzel
II. Medizinische Klinik u. Poliklinik, Johannes Gutenberg-Universität
Langenbeckstraße 1
55101 Mainz
Email: muenzel@2-med.klinik.uni-mainz.de