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Erschienen in: Notfall +  Rettungsmedizin 6/2012

01.08.2012 | Leitthema

Routinemäßige sofortige Koronarographie/PCI

Ist sie bei möglicher kardialer Ursache eines Kreislaufstillstandes sinnvoll?

verfasst von: Prof. Dr. H.-R. Arntz

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 6/2012

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Zusammenfassung

Hintergrund

Die ERC-Leitlinien empfehlen im Rahmen der Nachbehandlung nach Wiederbelebung eine routinemäßige Koronarographie und eventuelle perkutane Koronarintervention (PCI) bei Patienten mit vermuteter koronarer Ursache des Kreislaufstillstands. Neben dem Analogschluss zum unkomplizierten Infarkt ist die Grundlage hierfür eine angebliche diagnostische Unsicherheit bezüglich Koronarverschlüssen, die eine Abklärung notwendig machen würde. Daneben werden zahlreiche Berichte und Fallserien zur Überlebensrate mit gutem neurologischem Outcome für die Empfehlungen herangezogen. Die ungewöhnlich guten Ergebnisse sind möglicherweise Folge einer im Einzelfall nicht sicher nachvollziehbaren Patientenselektion und eines Publikationsbias. Hierfür spricht v. a., dass der Einfluss der PCI bei ST-Streckenhebungsinfarkt (STEMI) bzw. Non-STEMI-ACS mit Kreislaufstillstand auf das Outcome höher zu sein scheint als bei routinemäßiger Anwendung im Rahmen eines unkomplizierten STEMI oder eines Non-STEM-ACS.

Empfehlung

Aus den offenen Fragen ergeben sich die Forderung und Notwendigkeit, künftige Leitlinien auf den Boden einer ausreichend großen kontrollierten randomisierten Studie zu stellen, aus der der tatsächliche Nutzen eines interventionellen Vorgehens nach erfolgreicher CPR hervorgeht. Die Tatsache, dass das Risiko einer Intervention zumindest bei erfolgreicher PCI relativ begrenzt zu sein scheint und einige Publikationen aus nichtrandomisierten Studien reichen als Begründung der Empfehlungen für diese kritisch kranken Patienten nicht aus.
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Metadaten
Titel
Routinemäßige sofortige Koronarographie/PCI
Ist sie bei möglicher kardialer Ursache eines Kreislaufstillstandes sinnvoll?
verfasst von
Prof. Dr. H.-R. Arntz
Publikationsdatum
01.08.2012
Verlag
Springer-Verlag
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 6/2012
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-011-1570-5

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