Aktuelle Kardiologie 2012; 1(1): 30-37
DOI: 10.1055/s-0031-1298363
Georg Thieme Verlag KG Stuttgart · New York

Stabile Angina pectoris: wann Revaskularisation und wann Medikament?

Stable Angina: When Revascularisation and When Medication Alone?
M. Vöhringer
1   Robert-Bosch-Krankenhaus Stuttgart
U. Sechtem
1   Robert-Bosch-Krankenhaus Stuttgart
› Author Affiliations
Further Information

Publication History

Publication Date:
30 March 2012 (online)


Die beiden Standbeine der Behandlung der stabilen Angina pectoris sind einerseits die medikamentöse Therapie und andererseits die Revaskularisierung mittels perkutaner Koronarintervention (PCI) oder Bypass-Chirurgie. In den letzten Jahrzehnten wurden konservative und revaskularisierende Behandlungsoptionen wesentlich weiterentwickelt. Beide Therapieformen haben auf der Basis randomisierter Studien ihren Platz in der Behandlung der verschiedenen Stadien der koronaren Herzerkrankung. Zahlreiche Untersuchungen belegen allerdings, dass lediglich Hochrisikopatienten prognostisch von einer zusätzlichen Revaskularisierungsmaßnahme profitieren. Viele Patienten können allein durch medikamentöse Therapie erfolgreich prognostisch und auch symptomatisch behandelt werden. Spricht die Angina pectoris nicht ausreichend an, können Patienten nach einem medikamentösen Therapieversuch im Verlauf immer noch revaskularisiert werden. Dieser Artikel ist eine Standortbestimmung anhand der aktuellen Studienlage entlang eines Fallbeispiels.


The two footholds in the therapy of stable angina pectoris are medication and revascularisation by PCI or bypass surgery. Both are supported by evidence from several randomized controlled trials. With increasing effectiveness of drug therapy in the last years it becomes evident that additional revascularisation is only beneficial for high risk patients. Many patients can be treated by drug therapy alone with favourable prognostic and symptomatic outcomes. If the angina does not respond to medication patients can still be referred to revascularisation without prognostic drawback. This article summarises the actual evidence along a clinical case.

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