Zusammenfassung
In diesem Beitrag werden die aktuellen Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) aus dem Jahr 2017 zur Diagnostik und Therapie des akuten ST-Strecken-Hebungs-Infarkts (STEMI) dargelegt und v. a. die Änderungen im Vergleich zu den früheren STEMI-Leitlinien von 2012 herausgearbeitet. Die primäre perkutane Koronarintervention (PCI) bleibt die bevorzugte Reperfusionstherapie. Veränderungen hinsichtlich der Revaskularisation betreffen v. a. Empfehlungen zur Wahl des radialen Zugangsweges, zur Verwendung von Drug-eluting-Stents anstelle von Bare-metal-Stents sowie zur kompletten Revaskularisation und Vermeidung der Thrombusaspiration. Bei der Begleittherapie während der PCI wurde Bivalirudin herabgestuft. Die Indikation für eine O2-Therapie ist nur noch gegeben bei einer O2-Sättigung von weniger als 90 %. Die intraaortale Ballonpumpe sollte im kardiogenen Schock nicht mehr verwendet werden. Neue Empfehlungen gibt es auch in Bezug auf die Dauer der dualen Antiplättchentherapie für Patienten, bei denen nach den initialen 12 Monaten kein Blutungsereignis aufgetreten ist. Neue überarbeitete Abschnitte betreffen den Myokardinfarkt ohne relevante Koronarstenosen, die Einführung von Qualitätsindikatoren für Herzinfarktnetzwerke und neue Definitionen für die Zeiten bis zur Reperfusion.
Abstract
This article gives an update on the management of acute ST-segment elevation myocardial infarction (STEMI) according to the recently released European Society of Cardiology guidelines 2017 and the modifications are compared to the previous STEMI guidelines from 2012. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy. New guideline recommendations relate to the access site with a clear preference for the radial artery, use of drug-eluting stents over bare metal stents, complete revascularization during the index hospitalization, and avoidance of routine thrombus aspiration. For periprocedural anticoagulation during PCI, bivalirudin has been downgraded. Oxygen treatment should be administered only if oxygen saturation is <90%. In cardiogenic shock, intra-aortic balloon pumps should no longer be used. New recommendations are in place with respect to the duration of dual antiplatelet therapy for patients without bleeding events during the first 12 months. Newly introduced sections cover myocardial infarction with no relevant stenosis of the coronary arteries (MINOCA), the introduction of new indicators for quality of care for myocardial infarction networks and new definitions for the time to reperfusion.
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H. Thiele, S. Desch und S. de Waha geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
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Thiele, H., Desch, S. & de Waha, S. Akuter Myokardinfarkt bei Patienten mit ST-Strecken-Hebungs-Infarkt. Herz 42, 728–738 (2017). https://doi.org/10.1007/s00059-017-4641-7
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DOI: https://doi.org/10.1007/s00059-017-4641-7