Zusammenfassung
Ist ein ST-Streckenhebungsinfarkt durch klar definierte EKG-Zeichen eines 12-Kanal-EKGs
bei entsprechender Klinik nachgewiesen, kann die Therapiestrategie mehreren Wegen
folgen. Wichtig für die Wahl der Strategie sind dabei die Symptomdauer, die Erreichbarkeit
eines qualifizierten Interventionszentrums, die Logistik des Rettungsdienstes, der
klinische Zustand des Patienten, das Vorhandensein von Kontraindikationen gegen eine
Lysetherapie und die Präferenz des Patienten selbst, die bei der Umsetzung der Leitlinien
der Deutschen Gesellschaft für Kardiologie mitberücksichtigt werden müssen. Scheinbar
steht die Thrombolyse in Konkurrenz zur Intervention, beide Verfahren können sich
aber auch ergänzen. Beispielsweise kann der Thrombolyse routinemäßig die Intervention
folgen, die so genannte „Facilitated PCI”. Eine Ausweitung des Facilitated-PCI-Verfahrens
könnte durch Kombination mit Thrombolyse in niedriger Dosis mit zusätzlicher Gabe
eines Gp IIb/IIIa-Rezeptorblockers erreicht werden. Eine weitere Möglichkeit besteht
in der so genannten Rescue-Intervention. Im Rahmen der Verbringung eines Patienten
zur primären PCI ist die Gabe eines Gp IIb/IIIa-Rezeptorblockers bereits durch den
Notarzt oder im peripheren Krankenhaus in Vorbereitung zur Intervention eine weitere
therapeutische Option.
Summary
Once an ST elevation myocardial infarction has been confirmed by clearly defined ECG
signs of a 12-channel ECG recording, in a patient with relevant clinical findings,
the therapeutic strategy has a choice of several options. Of importance when deciding
what strategy to follow are the parameters duration of symptoms, distance to a specialised
percutaneous coronary intervention (PCI) centre, the logistics of the medical rescue
service, the clinical state of the patient, the presence of contraindications for
thrombolytic therapy, and the patient's own preference, all of which need to be taken
into account when implementing the guidelines of the German Society for Cardiology.
Although thrombolysis appears to be in competition with PCI, the two procedures can
complement each other, for example, thrombolysis can be applied routinely following
PCI - so-called facilitated PCI. This latter procedure might also be expanded by combining
it with thrombolysis at a low dose, with the additional administration of a GpIIb/IIIa
receptor blocker. Another option is the so-called rescue intervention. During transport
of the patient to primary PCI, administration of a GpIIb/IIIa receptor blockers already
by the emergency physician or in the peripheral hospital in preparation for coronary
intervention is yet another option.
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Anschrift des Verfassers
Prof. Dr. med. Hans-Richard Arntz
Charité, Campus Benjamin Franklin, Medizinische Klinik II
Hindenburgdamm 30
12200 Berlin
Email: hans-richard.arntz@charite.de
