Zusammenfassung
Seit 2008 baut die Deutsche Gesellschaft für Kardiologie ein Netzwerk von zertifizierten Chest Pain Units (CPU) auf. Generelles Ziel einer CPU ist es, einen akuten oder neu aufgetretenen unklaren Thoraxschmerz rasch und zielgerichtet abzuklären und umgehend therapeutische Maßnahmen einzuleiten. Grundlage für den bisherigen Zertifizierungsprozess waren Kriterien, die von der Task Force CPU festgelegt und veröffentlicht worden sind. Sie regeln die räumlichen und apparativen Voraussetzungen sowie die diagnostischen und therapeutischen Maßnahmen bei Patienten mit akutem Brustschmerz. Weiterhin werden die Anforderungen an Kooperationspartner sowie die Ausbildungsvoraussetzungen des Personals einer CPU festgelegt. Der Prozess der Zertifizierung wird von der DGK durchgeführt. Mittlerweile sind 206 CPUs zertifiziert und insgesamt 128 CPUs nach einem Zeitraum von 3 Jahren rezertifiziert worden. Aktuell wurden die Zertifizierungskriterien überarbeitet und entsprechend neuen Leitlinien aktualisiert.
Abstract
Since 2008 the German Cardiac Society (DGK) has been establishing a network of certified chest pain units (CPUs). The goal of CPUs was and is to carry out differential diagnostics of acute or newly occurring chest pain of undetermined origin in a rapid and goal-oriented manner and to take immediate therapeutic measures. The basis for the previous certification process were criteria that have been established and published by the task force on CPUs. These criteria regulate the spatial and technical requirements and determine diagnostic and therapeutic strategies in patients with chest pain. Furthermore, the requirements for the organization of CPUs and the training requirements for the staff of a CPU are defined. The certification process is carried out by the DGK and currently 206 CPUs are certified and 128 CPUs have been recertified after running for a period of 3 years. The certification criteria have now been revised and updated according to new guidelines.
Literatur
Breuckmann F, Post F, Giannitsis E et al (2008) Kriterien der Deutschen Gesellschaft für Kardiologie - Herz- und Kreislaufforschung für „Chest-Pain-Units“. Kardiologe 2(5):389–394
http://cpu.dgk.org/index.php?id=158
Perings S, Smetak M, Block M et al (2010) Konsensuspapier der Task Force „Brustschmerz.Ambulanz“ der Deutschen Gesellschaft für Kardiologie - Herz- und Kreislaufforschung. Kardiologe 4:208–213
Hamm CW, Bassand JP, Agewall S et al (2011) ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32(23):2999–3054
Arntz HR, Bossaert LL, Danchin N, Nikolaou NI (2010) European Resuscitation Council Guidelines for Resuscitation 2010 Section 5. Initial management of acute coronary syndromes. Resuscitation 81(10):1353–1363
Keller T, Post F, Tzikas S et al (2010) Improved outcome in acute coronary syndrome by establishing a chest pain unit. Clin Res Cardiol 99(3):149–155
Kugelmass A, Anderson A, Brown P (2004) Does having a chest pain center impact the treatment and survival of acute myocardial infarction patients? Circulation 110:111 (abstract)
Post F, Genth-Zotz S, Munzel T (2007) Aktueller Stellenwert einer Chest Pain Unit in Deutschland. Herz 32(5):435–437
Post F, Genth-Zotz S, Munzel T (2007) Versorgung des akuten Koronarsyndroms in einer Chest Pain Unit – Eine sinnvolle Neuerung in Deutschland. Klinikarzt 36:375–380
Dougan JP, Mathew TP, Riddell JW et al (2001) Suspected angina pectoris: a rapid-access chest pain clinic. QJM 94(12):679–686
Goodacre S, Dixon S (2005) Is a chest pain observation unit likely to be cost effective at my hospital? Extrapolation of data from a randomised controlled trial. Emerg Med J 22(6):418–422
Goodacre S, Nicholl J, Dixon S et al (2004) Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care. BMJ 328(7434):254
Tzikas S, Keller T, Post F et al (2010) Patient satisfaction in acute coronary syndrome. Improvement through the establishment of a chest pain unit. Herz 35(6):403–409
http://cpu.dgk.org/index.php?id=274
Post F, Giannitsis E, Riemer T et al (2012) Pre- and early in-hospital procedures in patients with acute coronary syndromes: first results of the „German chest pain unit registry“. Clin Res Cardiol 101(12):983–991
Maier LS, Darius H, Giannitsis E et al (2013) The German CPU registry: comparison of troponin positive to troponin negative patients. Int J Cardiol 168(2):1651–1653
Akkerhuis KM, Klootwijk PA, Lindeboom W et al (2001) Recurrent ischaemia during continuous multilead ST-segment monitoring identifies patients with acute coronary syndromes at high risk of adverse cardiac events; meta-analysis of three studies involving 995 patients. Eur Heart J 22(21):1997–2006
Holmvang L, Andersen K, Dellborg M et al (1999) Relative contributions of a single-admission 12-lead electrocardiogram and early 24-hour continuous electrocardiographic monitoring for early risk stratification in patients with unstable coronary artery disease. Am J Cardiol 83(5):667–674
Hiratzka LF, Bakris GL, Beckman JA et al (2010) ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 121(13):e266–e369
Erbel R, Alfonso F, Boileau C et al (2001) Diagnosis and management of aortic dissection. Eur Heart J 22(18):1642–1681
Torbicki A, Perrier A, Konstantinides S et al (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315
Steg PG, James SK, Atar D et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33(20):2569–2619
Keller T, Zeller T, Peetz D et al (2009) Sensitive troponin I assay in early diagnosis of acute myocardial infarction. N Engl J Med 361(9):868–877
Kurz K, Giannitsis E, Becker M et al (2011) Comparison of the new high sensitive cardiac troponin T with myoglobin, h-FABP and cTnT for early identification of myocardial necrosis in the acute coronary syndrome. Clin Res Cardiol 100(3):209–215
Bandstein N, Ljung R, Johansson M, Holzmann MJ (2014) Undetectable high sensitivity cardiac troponin t level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 63:2569–2578
Body R, Carley S, McDowell G et al (2011) Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol 58(13):1332–1339
Reichlin T, Schindler C, Drexler B et al (2012) One-hour rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T. Arch Intern Med 172(16):1211–1218
Cullen L, Mueller C, Parsonage WA et al (2013) Validation of high-sensitivity troponin I in a 2-hour diagnostic strategy to assess 30-day outcomes in emergency department patients with possible acute coronary syndrome. J Am Coll Cardiol 62(14):1242–1249
Maisel A, Mueller C, Neath SX et al (2013) Copeptin helps in the early detection of patients with acute myocardial infarction: primary results of the CHOPIN trial (Copeptin Helps in the early detection Of Patients with acute myocardial INfarction). J Am Coll Cardiol 62(2):150–160
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 7;36(6):369–376
Blomkalns AL, Gibler WB (2005) Chest pain unit concept: rationale and diagnostic strategies. Cardiol Clin 23(4):411–421
http://www.outcomes-umassmed.org/grace/
Hamm CW (2009) Kommentar zu den Leitlinien der European Society of Cardiology (ESC) zur Diagnose und Therapie des akuten Koronarsyndroms ohne ST-Strecken-Hebung (NSTE-ACS). Kardiologe 3(2):81–100
Mehta SR, Granger CB, Boden WE et al (2009) Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360(21):2165–2175
Penaloza A, Melot C, Motte S (2011) Comparison of the Wells score with the simplified revised Geneva score for assessing pretest probability of pulmonary embolism. Thromb Res 127(2):81–84
Shirakabe A, Hata N, Yokoyama S et al (2008) Diagnostic score to differentiate acute aortic dissection in the emergency room. Circ J 72(6):986–990
Uthoff H, Staub D, Socrates T et al (2010) PROCAM-, FRAMINGHAM-, SCORE- and SMART-risk score for predicting cardiovascular morbidity and mortality in patients with overt atherosclerosis. Vasa 39(4):325–333
Bavry AA, Kumbhani DJ, Rassi AN et al (2006) Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 48(7):1319–1325
O’Donoghue M, Boden WE, Braunwald E et al (2008) Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA 300(1):71–80
Dirschedl P, Lenz S, Lollgen H, Fahrenkrog U (1996) Validity of telephone ECG multichannel transmission. Z Kardiol 85(9):677–683
Siebens K, Moons P, De Geest S et al (2007) The role of nurses in a chest pain unit. Eur J Cardiovasc Nurs 6(4):265–272
Breuckmann F, Post F, Erbel R, Munzel T (2009) Acute thoracic pain: chest pain unit – the certification campaign of the German Society of Cardiology. Herz 34(3):218–223
Illmann A, Riemer T, Erbel R et al (2014) Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry. Clin Res Cardiol 103(1):29–40
Nowak B, Giannitsis E, Riemer T et al (2012) Self-referral to chest pain units: results of the German CPU-registry. Eur Heart J Acute Cardiovasc Care 1(4):312–319
Post F, Gori T, Senges J et al (2012) Establishment and progress of the chest pain unit certification process in Germany and the local experiences of Mainz. Eur Heart J 33(6):682–686
Windecker S, Kolh P, Alfonso F et al (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35(37):2541–2619
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Den Interessenkonflikt der Autoren finden Sie online auf der DGK-Homepage unter http://leitlinien.dgk.org/ bei der entsprechenden Publikation.
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Post, F., Giannitsis, E., Darius, H. et al. Kriterien der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung für „Chest Pain Units“. Kardiologe 9, 171–181 (2015). https://doi.org/10.1007/s12181-014-0646-0
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DOI: https://doi.org/10.1007/s12181-014-0646-0