Nach wie vor bildet die konservative Therapie das Fundament in der Behandlung des
chronischen Koronarsyndroms. Die aktuellen ESC-Leitlinien betonen die Bedeutung einer
individualisierten Therapie, die sich an den Pathomechanismen und den spezifischen
Bedürfnissen der Patienten orientiert. Die komplexe Pathophysiologie des CCS unterstreicht
die Bedeutung eines umfassenden Therapieansatzes, der konservative und interventionelle
Maßnahmen integriert.
Abstract
CCS management, based on the 2024 ESC Guidelines, a cornerstone of contemporary cardiology,
aims to prevent cardiovascular events, alleviate symptoms, and enhance quality of
life through conservative and invasive strategies. Non-invasive approaches, encompassing
patient education, lifestyle interventions, and optimized pharmacological treatments,
have demonstrated significant benefits in prognosis and quality of life. The guidelines
advocate for a patient-centered approach, tailoring therapies to pathophysiological
mechanisms, comorbidities, and individual needs. Pharmacological strategies integrate
antithrombotic, lipid-lowering, RAAS-blocking, anti-inflammatory, and antidiabetic
agents for event prevention, alongside antianginal medications for symptom relief.
Invasive interventions remain essential for high-risk patients with obstructive coronary
artery disease (e.g., left main disease, three-vessel disease, or proximal LAD involvement)
or refractory angina despite optimal medical therapy. However, the growing efficacy
of medical management increasingly challenges the incremental benefits of early revascularization.
The guidelines also highlight underdiagnosed conditions such as ANOCA (Angina with
Non-Obstructive Coronary Arteries) and INOCA (Ischemia with Non-Obstructive Coronary
Arteries). Recognizing diverse endotypes, including microvascular dysfunction and
vasospastic angina, enables precise and individualized therapeutic approaches. Conservative
therapy remains the foundation of CCS management, demanding a holistic, multidisciplinary,
and patient-centered approach to optimize outcomes and improve quality of life.
Schlüsselwörter
chronisches Koronarsyndrom - koronare Herzerkrankung - Therapie - lipidsenkend
- antithrombotisch - antianginös - Mikrozirkulationsstörung - ANOCA - INOCA
Keywords
chronic coronary syndrome - coronary artery disease - therapy - lipid-lowering -
antithrombotic - antianginal - microvascular disease - ANOCA - INOCA
