Interventionelle Strategie beim NSTE-ACS – Diagnostik, Risikoabschätzung und optimale Intervention

Leitsymptom des akuten Koronarsyndroms (ACS) ist der akute Thoraxschmerz. In der Diagnostik des ACS sind neben der typischen anhaltenden Angina pectoris-Symptomatik das EKG und laborchemische Analysen, wie auch bildgebende Verfahren von zentraler Bedeutung. Die Koronarangiografie liefert umfangreiche Informationen über das Vorhandensein und den Schweregrad von Koronarstenosen und ist diagnostischer Goldstandard bei Patienten mit hohem Risiko. Die koronare Revaskularisation führt bei Patienten mit NSTE-ACS zu einer Verbesserung der Beschwerden, zu einer Prognoseverbesserung hinsichtlich der Mortalität und auch zu verkürzten Krankenhausaufenthalten. Bei Patienten mit niedrigem und intermediärem Risiko (GRACE-Risk-Score < 140), wie auch hohem Risiko (GRACE Risk Score > 140) konnte durch eine frühe Koronarangiografie eine absolute Risikoreduktion hinsichtlich Mortalität und Myokardinfarkt nachgewiesen werden. Bei der Entscheidung über eine invasive bzw. non-invasive Strategie und über den optimalen Zeitpunkt der Therapie sollte unter Berücksichtigung des breiten Risikospektrums bei NSTE-ACS das individuelle Risiko des Patienten einbezogen werden.

Cardinal symptom of acute coronary syndrome (ACS) is acute thoracic pain. For the diagnosis of ACS, besides the typical persisting angina pectoris symptomatic in ECG, laboratory analyses as well as imaging procedures are of central importance. Coronary angiography provides comprehensive information on the presence and severity of coronary stenoses and is the diagnostic gold standard for high-risk patients. Coronary revascularization in patients with NSTE-ACS leads to relief of complaints, improvement of prognosis with regard to mortality and also to shorter hospitalization periods. In patients with lower or intermediate risks (GRACE risk score < 140), as well as those with high risks (GRACE risk score > 140), by means of an early coronary angiography an absolute risk reduction with regard to mortality and myocardial infarction can be detected. For decision making with respect to invasive or non-invasive strategies and about the optimal timing of therapy the patient's individual risk profile should be taken into account under consideration of the broad risk spectrum of NSTE-ACS.

Key words

NSTE-ACS - acute coronary syndrome (ACS) - ECG - coronary angiography - GRACE risk score - intervention

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