Skip to main content
Erschienen in: Zeitschrift für Gerontologie und Geriatrie 4/2018

30.05.2018 | Akutes Koronarsyndrom | CME

Akutes Koronarsyndrom beim älteren Menschen

verfasst von: Dr. med. D. Eckner, S. Popp, S. Wicklein, M. Pauschinger

Erschienen in: Zeitschrift für Gerontologie und Geriatrie | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Zusammenfassung

Das akute Koronarsyndrom (ACS) – gegliedert in „ST-elevation myocardial infarction“ (STEMI), „non-ST-segment elevation acute coronary syndrome“ (NSTE-ACS) und instabile Angina pectoris – stellt besonders beim älteren Menschen eine besondere Herausforderung in Bezug auf Diagnostik und Therapie dar. Begonnen mit der ggf. schwierigen Anamnese über die laborchemischen Befunde bis hin zu Besonderheiten in EKG, Echokardio- und Angiographie sollten diese Patienten different zu Jüngeren betrachtet werden. Aufgrund der besonders im hohen Alter bestehenden Mortalität und Morbidität nach ACS gilt es, evidente Strategien in Diagnostik und Therapie einzuhalten und speziell geschultes Personal für Menschen mit akutem Brustschmerz einzusetzen, um Prognose und Lebensqualität der Betroffenen zu bessern. Der erste wichtige Schritt sind zertifizierte „chest pain units“, die die reibungslose Diagnostik und Therapie sicherstellen und die innerklinischen Entscheidungsprozesse positiv beeinflussen.
Literatur
2.
Zurück zum Zitat Leon MB, Smith CR (2016) Transcatheter aortic-valve replacement. N Engl J Med 375(7):700–701PubMed Leon MB, Smith CR (2016) Transcatheter aortic-valve replacement. N Engl J Med 375(7):700–701PubMed
3.
Zurück zum Zitat Ibánez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P (2017) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol 70(12):1082CrossRefPubMed Ibánez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P (2017) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol 70(12):1082CrossRefPubMed
4.
Zurück zum Zitat Dai X, Busby-Whitehead J, Alexander KP (2016) Acute coronary syndrome in the older adults. J Geriatr Cardiol 13(2):101–108PubMedPubMedCentral Dai X, Busby-Whitehead J, Alexander KP (2016) Acute coronary syndrome in the older adults. J Geriatr Cardiol 13(2):101–108PubMedPubMedCentral
5.
Zurück zum Zitat Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED (2001) Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 286(6):708–713CrossRefPubMed Lee PY, Alexander KP, Hammill BG, Pasquali SK, Peterson ED (2001) Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 286(6):708–713CrossRefPubMed
6.
Zurück zum Zitat Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM, Cardiology AHACoC, Cardiology SoG (2007) Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115(19):2549–2569CrossRefPubMed Alexander KP, Newby LK, Cannon CP, Armstrong PW, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM, Cardiology AHACoC, Cardiology SoG (2007) Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115(19):2549–2569CrossRefPubMed
7.
Zurück zum Zitat Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM, Cardiology AHACoC, Cardiology SoG (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115(19):2570–2589CrossRefPubMed Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW, Van de Werf F, White HD, Weaver WD, Naylor MD, Gore JM, Krumholz HM, Ohman EM, Cardiology AHACoC, Cardiology SoG (2007) Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 115(19):2570–2589CrossRefPubMed
8.
Zurück zum Zitat Investigators G (2001) Rationale and design of the GRACE (global registry of acute coronary events) project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J 141(2):190–199CrossRef Investigators G (2001) Rationale and design of the GRACE (global registry of acute coronary events) project: a multinational registry of patients hospitalized with acute coronary syndromes. Am Heart J 141(2):190–199CrossRef
9.
Zurück zum Zitat White HD, Barbash GI, Califf RM, Simes RJ, Granger CB, Weaver WD, Kleiman NS, Aylward PE, Gore JM, Vahanian A, Lee KL, Ross AM, Topol EJ (1996) Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation 94(8):1826–1833CrossRefPubMed White HD, Barbash GI, Califf RM, Simes RJ, Granger CB, Weaver WD, Kleiman NS, Aylward PE, Gore JM, Vahanian A, Lee KL, Ross AM, Topol EJ (1996) Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global Utilization of Streptokinase and TPA for Occluded coronary arteries trial. Circulation 94(8):1826–1833CrossRefPubMed
10.
Zurück zum Zitat Santos IS, Goulart AC, Brandão RM, Santos RC, Bittencourt MS, Sitnik D, Pereira AC, Pastore CA, Samesima N, Lotufo PA, Bensenor IM (2015) One-year mortality after an acute coronary event and its clinical predictors: the ERICO study. Arq Bras Cardiol 105(1):53–64PubMedPubMedCentral Santos IS, Goulart AC, Brandão RM, Santos RC, Bittencourt MS, Sitnik D, Pereira AC, Pastore CA, Samesima N, Lotufo PA, Bensenor IM (2015) One-year mortality after an acute coronary event and its clinical predictors: the ERICO study. Arq Bras Cardiol 105(1):53–64PubMedPubMedCentral
11.
Zurück zum Zitat Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, Montalescot G, Investigators G (2004) Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the global registry of acute coronary events. Chest 126(2):461–469CrossRefPubMed Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, Montalescot G, Investigators G (2004) Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the global registry of acute coronary events. Chest 126(2):461–469CrossRefPubMed
12.
Zurück zum Zitat Ladwig KH, Fang X, Wolf K, Hoschar S, Albarqouni L, Ronel J, Meinertz T, Spieler D, Laugwitz KL, Schunkert H (2017) Comparison of delay times between symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women 〈65 years versus ≥65 years of age.: findings from the multicenter munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study. Am J Cardiol 120(12):2128–2134CrossRefPubMed Ladwig KH, Fang X, Wolf K, Hoschar S, Albarqouni L, Ronel J, Meinertz T, Spieler D, Laugwitz KL, Schunkert H (2017) Comparison of delay times between symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women 〈65 years versus ≥65 years of age.: findings from the multicenter munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study. Am J Cardiol 120(12):2128–2134CrossRefPubMed
13.
Zurück zum Zitat Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). G Ital Cardiol 17(10):831–872 Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). G Ital Cardiol 17(10):831–872
14.
Zurück zum Zitat Roos A, Bandstein N, Lundbäck M, Hammarsten O, Ljung R, Holzmann MJ (2017) Stable high-sensitivity cardiac troponin T levels and outcomes in patients with chest pain. J Am Coll Cardiol 70(18):2226–2236CrossRefPubMed Roos A, Bandstein N, Lundbäck M, Hammarsten O, Ljung R, Holzmann MJ (2017) Stable high-sensitivity cardiac troponin T levels and outcomes in patients with chest pain. J Am Coll Cardiol 70(18):2226–2236CrossRefPubMed
15.
Zurück zum Zitat Mehilli J, Hamm C, Landmesser U, Massberg S (2016) Kommentar zu den 2015-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des akuten Koronarsyndroms ohne ST-Hebungen (NSTE-ACS). Kardiologe 10:351–358CrossRef Mehilli J, Hamm C, Landmesser U, Massberg S (2016) Kommentar zu den 2015-Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zum Management des akuten Koronarsyndroms ohne ST-Hebungen (NSTE-ACS). Kardiologe 10:351–358CrossRef
16.
Zurück zum Zitat Jensen MB, Sloth E, Larsen KM, Schmidt MB (2004) Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol 21(9):700–707CrossRefPubMed Jensen MB, Sloth E, Larsen KM, Schmidt MB (2004) Transthoracic echocardiography for cardiopulmonary monitoring in intensive care. Eur J Anaesthesiol 21(9):700–707CrossRefPubMed
17.
Zurück zum Zitat Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, Rudolph M, Uddin S, Weigand MA, Müller E, Walcher F (2010) Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital FaaM. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 81(11):1527–1533CrossRefPubMed Breitkreutz R, Price S, Steiger HV, Seeger FH, Ilper H, Ackermann H, Rudolph M, Uddin S, Weigand MA, Müller E, Walcher F (2010) Emergency Ultrasound Working Group of the Johann Wolfgang Goethe-University Hospital FaaM. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation 81(11):1527–1533CrossRefPubMed
18.
Zurück zum Zitat Malkin CJ, Prakash R, Chew DP (2012) The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2(1):e540CrossRefPubMedPubMedCentral Malkin CJ, Prakash R, Chew DP (2012) The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2(1):e540CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Fox KA, Fitzgerald G, Puymirat E, Huang W, Carruthers K, Simon T, Coste P, Monsegu J, Steg GP, Danchin N, Anderson F (2014) Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open 4(2):e4425CrossRefPubMedPubMedCentral Fox KA, Fitzgerald G, Puymirat E, Huang W, Carruthers K, Simon T, Coste P, Monsegu J, Steg GP, Danchin N, Anderson F (2014) Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open 4(2):e4425CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM, Investigators A (2015) Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 131(24):2143–2150CrossRefPubMed Stub D, Smith K, Bernard S, Nehme Z, Stephenson M, Bray JE, Cameron P, Barger B, Ellims AH, Taylor AJ, Meredith IT, Kaye DM, Investigators A (2015) Air versus oxygen in ST-segment-elevation myocardial infarction. Circulation 131(24):2143–2150CrossRefPubMed
22.
Zurück zum Zitat Hofmann R, James SK, Svensson L, Witt N, Frick M, Lindahl B, Östlund O, Ekelund U, Erlinge D, Herlitz J, Jernberg T (2014) DETermination of the role of OXygen in suspected acute myocardial infarction trial. Am Heart J 167(3):322–328CrossRefPubMed Hofmann R, James SK, Svensson L, Witt N, Frick M, Lindahl B, Östlund O, Ekelund U, Erlinge D, Herlitz J, Jernberg T (2014) DETermination of the role of OXygen in suspected acute myocardial infarction trial. Am Heart J 167(3):322–328CrossRefPubMed
23.
Zurück zum Zitat Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, Conner TA, Chertow GM, Bhatt DL, Shunk K, Parikh CR, McFalls EO, Brophy M, Ferguson R, Wu H, Androsenko M, Myles J, Kaufman J, Palevsky PM, Group PT (2018) Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 378(7):603–614CrossRefPubMed Weisbord SD, Gallagher M, Jneid H, Garcia S, Cass A, Thwin SS, Conner TA, Chertow GM, Bhatt DL, Shunk K, Parikh CR, McFalls EO, Brophy M, Ferguson R, Wu H, Androsenko M, Myles J, Kaufman J, Palevsky PM, Group PT (2018) Outcomes after angiography with sodium bicarbonate and acetylcysteine. N Engl J Med 378(7):603–614CrossRefPubMed
24.
Zurück zum Zitat Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, Rubartelli P, Briguori C, Andò G, Repetto A, Limbruno U, Cortese B, Sganzerla P, Lupi A, Galli M, Colangelo S, Ierna S, Ausiello A, Presbitero P, Sardella G, Varbella F, Esposito G, Santarelli A, Tresoldi S, Nazzaro M, Zingarelli A, de Cesare N, Rigattieri S, Tosi P, Palmieri C, Brugaletta S, Rao SV, Heg D, Rothenbühler M, Vranckx P, Jüni P, Investigators M (2015) Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 385(9986):2465–2476CrossRefPubMed Valgimigli M, Gagnor A, Calabró P, Frigoli E, Leonardi S, Zaro T, Rubartelli P, Briguori C, Andò G, Repetto A, Limbruno U, Cortese B, Sganzerla P, Lupi A, Galli M, Colangelo S, Ierna S, Ausiello A, Presbitero P, Sardella G, Varbella F, Esposito G, Santarelli A, Tresoldi S, Nazzaro M, Zingarelli A, de Cesare N, Rigattieri S, Tosi P, Palmieri C, Brugaletta S, Rao SV, Heg D, Rothenbühler M, Vranckx P, Jüni P, Investigators M (2015) Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 385(9986):2465–2476CrossRefPubMed
25.
Zurück zum Zitat Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver PN, MacCarthy PA, Fearon WF, Investigators FS (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360(3):213–224CrossRefPubMed Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver PN, MacCarthy PA, Fearon WF, Investigators FS (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360(3):213–224CrossRefPubMed
26.
Zurück zum Zitat Cannon CP, Lip GYH, Oldgren J (2018) Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 378(5):485–486PubMed Cannon CP, Lip GYH, Oldgren J (2018) Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 378(5):485–486PubMed
27.
Zurück zum Zitat Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, Korjian S, Daaboul Y, Lip GY, Cohen M, Husted S, Peterson ED, Fox KA (2016) Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 375(25):2423–2434CrossRefPubMed Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, Korjian S, Daaboul Y, Lip GY, Cohen M, Husted S, Peterson ED, Fox KA (2016) Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 375(25):2423–2434CrossRefPubMed
Metadaten
Titel
Akutes Koronarsyndrom beim älteren Menschen
verfasst von
Dr. med. D. Eckner
S. Popp
S. Wicklein
M. Pauschinger
Publikationsdatum
30.05.2018
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Gerontologie und Geriatrie / Ausgabe 4/2018
Print ISSN: 0948-6704
Elektronische ISSN: 1435-1269
DOI
https://doi.org/10.1007/s00391-018-1411-y

Weitere Artikel der Ausgabe 4/2018

Zeitschrift für Gerontologie und Geriatrie 4/2018 Zur Ausgabe

Mitteilungen der DGG

Mitteilungen der DGG

Journal Club

Journal Club