Akuter Myokardinfarkt mit persistierender ST-Elevation

Zusammenfassung

Die Thrombolyse ist eine längst etablierte Therapie des akuten Myokardinfarktes mit persistierender ST-Elevation (STEMI). Von dieser Therapieform profitieren jedoch überwiegend Patienten, die innerhalb der ersten zwei Stunden nach Beginn der Symptomatik behandelt werden. Im Gegensatz zur Thrombolyse ist die Effektivität der mechanischen Rekanalisation (PCI) in Bezug auf die komplette Reperfusion sehr hoch und unabhängig von der Dauer der Symptomatik. Nach den Ergebnissen kürzlich veröffentlichter Untersuchungen scheinen Patienten mit STEMI mehr von einer sofortigen Verlegung in ein PCI-Zentrum als von einer Thrombolyse vor Ort zu profitieren. Diese Strategie wird daher grundsätzlich in den aktualisierten Leitlinien deutscher und internationaler Fachgesellschaften befürwortet. Der transportbedingte Zeitverlust darf allerdings nicht länger als 60 bis 90 Minuten betragen.

Summary

Thrombolysis is an established treatment of acute myocardial infarction with persistent ST elevation (STEMI). Thrombolytic agents are most effective in patients who can be treated within two hours of symptom onset. On the other hand, the efficacy of mechanical recanalization (PCI) was consistently shown to be superior to thrombolysis regardless of the duration of symptoms. Recent studies further suggest that it may be preferable for small hospitals to rapidly transfer patients with acute STEMI to a PCI center rather than perform on-site thrombolysis. Therefore, this novel strategy is principally recommended in the updated guidelines of German and international cardiac societies. However, it is emphasized that the transfer-related delay of treatment should not exceed 60-90 minutes.

Schlüsselwörter

Myokardinfarkt - Thrombolyse - Intervention - Koronarangioplastie - Rekanalisation

Keywords

Myocardial infarction - thrombolysis - intervention - angioplasty - recanalization

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