Medikamentöse Therapie der stabilen koronaren Herzerkrankung

Zusammenfassung

Die stabile koronare Herzerkrankung ist eine Erkrankung mit einer relativ guten Prognose. Mit einer optimalen medikamentösen Therapie ist man in der Lage, die meisten Patienten symptomlos zu bekommen. Man unterscheidet Medikamente, die zur Kupierung des akuten Angina-pectoris-Anfalls eingesetzt werden (z. B. Nitratspray), von Medikamenten, die bei Patienten die Prognose verbessern (Statine, ASS, ACE-Hemmer und Betablocker) und Medikamenten, die vorrangig zur Symptomkontrolle eingesetzt werden (Ivabradin, Kalziumantagonisten, organische Nitrate oder Ranolazin). Der Zeitraum für eine duale Plättchentherapie, insbesondere nach Koronarstenting, liegt bei 4 Wochen (Bare Metal Stent) bis zu 1 Jahr (DES, ACS und beschichteter biodegradierbarer Stent). Die Dauer einer Triple-Therapie sollte so kurz wie möglich gehalten werden. Sollte der Patient unter einer optimalen medikamentösen Therapie noch symptomatisch sein, wird eine invasive Diagnostik und evtl. Revaskularisationsmaßnahmen empfohlen.

Abstract

Stable coronary artery disease is a disease with a relatively good prognosis. By using optimal medical therapy, one can manage to get rid of angina symptoms in almost all patients. Drugs used include short-acting nitrates for the treatment of the acute symptomatic patient, drugs known to improve prognosis in these patients such as aspirin, betablocker, statins and ACE-inhibitors and drugs that are used for symptom control such as calcium antagonists, organic nitrates, ranolazin and ivabradin. Stable CAD patients undergoing a PCI should get dual antiplatelet therapy for 4 weeks in case of a bare metal stent, 3–6 months in case of a DES and 1 year in case of a biodegradable stent or an ACS. Time for triple therapy should be as short as possible. In case that in response to optimal medical therapy the patient ist still symptomatic, a diagnostic cath and revascularisation therapy should be considered.

Schlüsselwörter

stabile koronare Herzerkrankung - Angina pectoris - organische Nitrate - Statine - Triple-Therapie - duale Antiplättchentherapie

Key words

stable coronary artery disease - angina pectoris - organic nitrates - statins - triple therapy - dual antiplatelet therapy

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