Diagnostik des chronischen Koronarsyndroms

Das chronische Koronarsyndrom kann auf unterschiedliche pathophysiologische epikardiale oder mikrovaskuläre Gefäßmechanismen zurückgeführt werden. In der aktuellen ESC-Leitlinie erfolgte die Entwicklung eines Diagnose-Algorithmus, basierend auf einer risikofaktorgewichteten individuellen Prätestwahrscheinlichkeit. Der folgende Beitrag stellt die diagnostischen Schritte und deren Bedeutung vor.

Abstract

The chronic coronary syndrome can be attributed to different pathophysiological epicardial or microvascular mechanisms. In the current ESC guideline from 2024, a diagnostic algorithm was developed based on a risk-factor-weighted individual pre-test probability. The baseline diagnostic includes anamnesis, electrocardiogram, and a laboratory chemical analysis, especially to exclude an acute coronary syndrome. The early and direct assessments for risk-factor-weighted individual pre-test probability are calculated by taking into account clinical symptoms, individual cardiovascular risk factors, age, and gender. Resting ECG, echocardiography and the evaluation of the peripheral arteries and data on possible known vascular calcifications in previous imaging examinations can further adjust and modify the pre-test probability. Non-invasive imaging methods (computed tomography angiography, magnetic resonance imaging, stress echocardiography, SPECT, PET) or invasive coronary angiography can be used to confirm or exclude the diagnosis of chronic coronary syndrome.

Kernaussagen

• Eine frühe und effektive Diagnostik des CCS ist von essenzieller Bedeutung.

• Eine Basisdiagnostik mit Anamnese, 12-Kanal-Ruhe-EKG und Bestimmung der kardialen Biomarker stellt die Grundlage dar, insbesondere zum Ausschluss eines akuten Koronarsyndroms (ACS).

• Anhand der individuellen risikofaktorgewichteten Prätestwahrscheinlichkeit wird die weitere Diagnostik definiert.

• Zur Bestätigung oder zum Ausschluss eines CCS dienen sowohl nicht invasive anatomische und funktionelle Bildgebungsmodalitäten als auch invasive Untersuchungsmethoden, die individuell gewählt und nach lokaler Verfügbarkeit durchgeführt werden sollen.

Schlüsselwörter

chronisches Koronarsyndrom - mikrovaskuläre Erkrankung - Prätestwahrscheinlichkeit - Angina pectoris - koronare CT

Keywords

chronic coronary syndrome - microvascular disease - pretest probability - Angina pectoris - coronary CT

Publikationsverlauf

Artikel online veröffentlicht:
06. Mai 2025

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