Aktuelle Marker der Myokardschädigung - Risikostratifizierung im akuten Koronarsyndrom

Zusammenfassung

Gut etabliert für Diagnose und Klassifikation von akuten Koronarsyndromen sind derzeit die kardialen Troponine. Sie sind bereits in der neuen Definition des akuten Myokardinfarkts und den Behandlungsrichtlinien für Patienten mit akutem Koronarsyndrom ohne ST-Streckenhebung implementiert. Sind die Troponinwerte erhöht, steigt auch das Risiko, ein kardiovaskuläres Ereignis zu erleiden, und die Patienten mit erhöhten Werten profitieren besonders von einem Einsatz von Glykoprotein-IIb/IIIa-Inhibitoren vor einem frühinvasiven Eingriff. Erst kürzlich wurden einige neue Biomarker identifiziert, die noch früher auf Ischämien und Nekrosen hinweisen und damit eine bessere Risikostratifizierung ermöglichen könnten. Erste Daten lassen vermuten, dass diese Marker unser Verständnis der komplexen Pathophysiologie des akuten Koronarsyndroms verbessern. Sie können so dazu beitragen, Patienten mit hohem von solchen mit geringem Risiko zu unterscheiden. Bislang sind diese neuen Risikomarker jedoch noch nicht ausreichend validiert. Bis dieses Problem gelöst und ein Evidenzgrad erreicht ist, der es erlaubt, die neuen Biomarker in die Leitlinienempfehlungen aufzunehmen, bleiben die kardialen Troponine daher der Goldstandard für Diagnose und Akutmanagement von Patienten mit akutem Koronarsyndrom.

Summary

Currently, cardiac troponins are well established for diagnosis and classification of acute coronary syndromes (ACS) and have been implemented in the new definition of acute myocardial infarction and management guidelines for patients with an acute coronary syndrome without ST-segment elevation. Elevated cardiac troponins predict higher cardiac event rates and identify patients who benefit most from an upstream use of GP IIb/IIIa inhibitors followed by early invasive strategy. More recently, several new biomarkers have been introduced for earlier detection of ischemia or necrosis and for improved risk stratification. Preliminary data suggest that these marker will improve our understanding of the complex pathophysiology inherent in acute coronary syndromes and might be helpful for discrimination of patients at high risk from those at very low risk. However, currently most markers are neither available for measurement on an automated platform nor have these markers been validated prospectively. Until the level of evidence for single new marker or implementation of multiple marker concepts has been obtained to allow for a guideline recommendation, cardiac troponins will remain the gold standard for diagnosis and acute management of patients with acute coronary syndrome.

Key words

acute coronary syndrome - troponins - novel biomarker - acute risk

Literatur

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1 chimeric 7E3 antiplatelet therapy in unstable angina refractory to standard treatment

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