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14.06.2022 | Akutes Koronarsyndrom | CME

Management des akuten Koronarsyndroms ohne ST-Strecken-Hebung

verfasst von: PD Dr. Maria Rubini Gimenez, Prof. Dr. Holger Thiele, PD Dr. med. Janine Pöss

Erschienen in: Herz | Ausgabe 4/2022

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Zusammenfassung

Der Sammelbegriff „akutes Koronarsyndrom“ (ACS) umfasst den ST-Strecken-Hebungs-Infarkt (STEMI) und das ACS ohne ST-Strecken-Hebung (NSTE-ACS). Letzteres umfasst den akuten Myokardinfarkt ohne ST-Strecken-Hebung (NSTEMI) und die instabile Angina pectoris. Nach der Diagnosestellung eines STEMI ist eine sofortige Zuweisung in das Herzkatheterlabor erforderlich; Diagnostik und Management des NSTE-ACS sind anspruchsvoller. Die aktuellen Leitlinien der European Society of Cardiology (ESC) zur Behandlung des NSTE-ACS wurden 2020 publiziert. Dabei werden die Themen Diagnostik, Risikostratifizierung, antithrombotische Therapie, invasive oder nicht-invasive Koronardiagnostik sowie die Langzeittherapie behandelt. Der Schwerpunkt der Leitlinie liegt auf der Verwendung hoch sensitiver kardialer Troponinassays (hs-cTn) in Verbindung mit verifizierten Diagnosealgorithmen, um eine zügige Triage-Entscheidung („rule-out“ = sicher kein NSTEMI oder „rule-in“ = NSTEMI wahrscheinlich) in der Notaufnahme oder der Chest Pain Unit zu ermöglichen.

Roffi M, Patrono C, Collet JP et al (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). Eur Heart J 37:267–315 CrossRef

Collet JP, Thiele H, Barbato E et al (2021) 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 42(14):1289–1367. https://doi.org/10.1093/eurheartj/ehaa575 CrossRefPubMed

Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction. Eur Heart J 40:237–269 CrossRef

Rubini Gimenez M (2021) Akuter Myokardinfarkt ohne ST-Hebung (NSTEMI): Wie Algorithmen die Diagnose beschleunigen. Dtsch Arztebl Int. https://doi.org/10.3238/PersKardio.2021.10.15.01 CrossRef

Ibanez B, James S, Agewall S et al (2017) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol (Engl Ed) 70:1082 CrossRef

Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction. Circulation 138:e618–e651 CrossRef

Chew DP, Lambrakis K, Blyth A et al (2019) A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: the rapid assessment of possible acute coronary syndrome in the emergency department with high-sensitivity troponin T study (RAPID-TnT). Circulation 140:1543–1556 CrossRef

Stoyanov KM, Hund H, Biener M et al (2020) RAPID-CPU: a prospective study on implementation of the ESC 0/1-hour algorithm and safety of discharge after rule-out of myocardial infarction. Eur Heart J Acute Cardiovasc Care 9:39–51 CrossRef

Twerenbold R, Costabel JP, Nestelberger T et al (2019) Outcome of applying the ESC 0/1-hour algorithm in patients with suspected myocardial infarction. J Am Coll Cardiol 74:483–494 CrossRef

10.

Reichlin T, Hochholzer W, Stelzig C et al (2009) Incremental value of copeptin for rapid rule out of acute myocardial infarction. J Am Coll Cardiol 54:60–68 CrossRef

11.

Mockel M, Searle J, Hamm C et al (2015) Early discharge using single cardiac troponin and copeptin testing in patients with suspected acute coronary syndrome (ACS): a randomized, controlled clinical process study. Eur Heart J 36:369–376 CrossRef

12.

Keller T, Tzikas S, Zeller T et al (2010) Copeptin improves early diagnosis of acute myocardial infarction. J Am Coll Cardiol 55:2096–2106 CrossRef

13.

Wildi K, Boeddinghaus J, Nestelberger T et al (2019) Comparison of fourteen rule-out strategies for acute myocardial infarction. Int J Cardiol 283:41–47 CrossRef

14.

Vargas KG, Kassem M, Mueller C et al (2016) Copeptin for the early rule-out of non-ST-elevation myocardial infarction. Int J Cardiol 223:797–804 CrossRef

15.

Mueller C, Mockel M, Giannitsis E et al (2018) Use of copeptin for rapid rule-out of acute myocardial infarction. Eur Heart J Acute Cardiovasc Care 7:570–576 CrossRef

16.

Restan IZ, Sanchez AY, Steiro OT et al (2022) Adding stress biomarkers to high-sensitivity cardiac troponin for rapid non-ST-elevation myocardial infarction rule-out protocols. Eur Heart J Acute Cardiovasc Care 11:201–212 CrossRef

17.

Chew DP, Astley CM, Luker H et al (2015) A cluster randomized trial of objective risk assessment versus standard care for acute coronary syndromes: rationale and design of the Australian GRACE risk score intervention study (AGRIS). Am Heart J 170:995–1004.e1 CrossRef

18.

Zeymer U, Schneider S, Zahn R, Andresen D (2014) Reported underuse of risk scores in patients with acute coronary syndromes without persistent ST elevations in clinical practice: results of a survey of the ALKK study group. Clin Res Cardiol 103:83–84 CrossRef

19.

Urban P, Mehran R, Colleran R et al (2019) Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the academic research consortium for high bleeding risk. Eur Heart J 40:2632–2653 CrossRef

20.

Ueki Y, Bar S, Losdat S et al (2020) Validation of the academic research consortium for high bleeding risk (ARC-HBR) criteria in patients undergoing percutaneous coronary intervention and comparison with contemporary bleeding risk scores. EuroIntervention 16:371–379 CrossRef

21.

Cao D, Mehran R, Dangas G et al (2020) Validation of the academic research consortium high bleeding risk definition in contemporary PCI patients. J Am Coll Cardiol 75:2711–2722 CrossRef

22.

Schupke S, Neumann FJ, Menichelli M et al (2019) Ticagrelor or prasugrel in patients with acute coronary syndromes. N Engl J Med 381:1524–1534 CrossRef

23.

Mauri L, Kereiakes DJ, Yeh RW et al (2014) Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med 371:2155–2166 CrossRef

24.

Bonaca MP, Braunwald E, Sabatine MS (2015) Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 373:1274–1275 PubMed

25.

Eikelboom JW, Connolly SJ, Bosch J et al (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 377:1319–1330 CrossRef

26.

Khan SU, Singh M, Valavoor S et al (2020) Dual antiplatelet therapy after percutaneous coronary intervention and drug-eluting stents: a systematic review and network meta-analysis. Circulation 142:1425–1436 CrossRef

27.

Gibson CM, Mehran R, Bode C et al (2016) Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 375:2423–2434 CrossRef

28.

Cannon CP, Bhatt DL, Oldgren J et al (2017) Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 377:1513–1524 CrossRef

29.

Lopes RD, Heizer G, Aronson R et al (2019) Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med 380:1509–1524 CrossRef

30.

Vranckx P, Valgimigli M, Eckardt L et al (2019) Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 394:1335–1343 CrossRef

31.

Poess J (2021) Akutes Koronarsyndrom ohne persistierende ST-Strecken-Hebung – was ist neu in den 2020 Leitlinien der ESC. Aktuel Kardiol 10(02):105–111 CrossRef

32.

Adlam D, Alfonso F, Maas A et al (2018) European society of cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 39:3353–3368 CrossRef

33.

Tamis-Holland JE, Jneid H, Reynolds HR et al (2019) Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American heart association. Circulation 139:e891–e908 CrossRef

34.

Pizzi C, Xhyheri B, Costa GM et al (2016) Nonobstructive versus obstructive coronary artery disease in acute coronary syndrome: a meta-analysis. J Am Heart Assoc 5(12):e4185. https://doi.org/10.1161/JAHA.116.004185 CrossRefPubMedPubMedCentral

35.

Safdar B, Spatz ES, Dreyer RP et al (2018) Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc 7(13):e9174 CrossRef

36.

Poess J (2021) Stellenwert von MINOCA beim N‑STEMI. Aktuel Kardiol 10(02):138–142 CrossRef

37.

Agewall S, Beltrame JF, Reynolds HR et al (2017) ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 38:143–153 PubMed

38.

Mach F, Baigent C, Catapano AL et al (2019) 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the task force for the management of dyslipidaemias of the European society of cardiology (ESC) and European atherosclerosis society (EAS). Eur Heart J 41:111–188 CrossRef

Titel: Management des akuten Koronarsyndroms ohne ST-Strecken-Hebung
verfasst von: PD Dr. Maria Rubini Gimenez
Prof. Dr. Holger Thiele
PD Dr. med. Janine Pöss
Publikationsdatum: 14.06.2022
Verlag: Springer Medizin
Schlagwörter: Akutes Koronarsyndrom
Nicht-ST-Hebungsinfarkt
Interventionelle Verfahren in der Kardiologie
EKG
Stabile Angina pectoris
Erschienen in: Herz / Ausgabe 4/2022
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-022-05120-y

Springer Medizin

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