Biomarker beim akuten Koronarsyndrom

Abstract

The fast and accurate triage of patients with suspected myocardial infarction is highly important. The determination of cardiac troponin is the clinical gold standard for the final diagnosis. Using high-sensitivity assays, lower troponin concentrations can be reliably measured. This approach enables accurate triage of patients in the emergency department after 1 hour: In approximately 40 % of all patients myocardial infarction can be reliably excluded and diagnosed in approximately 10 %. Each specific assay requires an individual cutoff concentration. Additional diagnostic tools, such as ECG, echocardiography or GRACE score, and the evaluation of differential diagnoses are also mandatory.

Kernaussagen

• Die schnelle und exakte Triagierung der Patienten mit vermutlichem Myokardinfarkt ist von hoher klinischer Bedeutung.

• Dabei stellt die Bestimmung des kardialen Troponins in Kombination mit einem EKG den klinischen Goldstandard in der Diagnostik dar.

• Durch Verwendung hochsensitiver Assays können niedrigere Troponinkonzentrationen zuverlässig gemessen werden. Dies ermöglicht es in der Notaufnahme viele Patienten bereits nach einer Stunde exakt zu triagieren: Bei ca. 40 % aller Patienten kann ein Myokardinfarkt sicher ausgeschlossen und bei ca. 10 % diagnostiziert werden.

• Wichtig ist, dass für jeden Troponin-Assay spezifische Grenzwerte beachtet werden müssen.

• Ergänzende diagnostische Mittel, wie die Echokardiografie oder der GRACE-Score, und die Abklärung von Differenzialdiagnosen sind integraler Bestandteil der weiteren Abklärung.

• Literatur

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