Behandlung des akuten Koronarsyndroms in Deutschland: Erfahrungen eines deutschen Clusters des GRACE-Registers

Zusammenfassung

Hintergrund: Das akute Koronarsyndroms (ACS) ist bis heute eine der wichtigsten Ursachen für Morbidität und Mortalität. Das Register „Global Registry of Acute Coronary Events (GRACE)” dokumentiert die Versorgung dieser Krankenhauspatienten mit allen Formen des ACS mit einer Nachbeobachtungszeit von 3 Monaten in Deutschland und weltweit.

Methoden: In der vorliegenden Studie wurden die Daten des GRACE²-Clusters Detmold mit den internationalen Daten (n = 31 070) verglichen. Insgesamt wurden zwischen Oktober 2001 und September 2005 die Daten von 849 Patienten mit Myokardinfarkt ohne (NSTEMI) oder mit ST-Hebung (STEMI) sowie instabiler Angina pectoris (IA) dokumentiert.

Ergebnisse: Im Vergleich hatten die Patienten im Cluster Detmold eine längere Prähospitalzeit (STEMI < 1 h: 13,9 vs. 17,0 %, p < 0,05); häufigere Interventionen beim STEMI (PCI 60,1 vs. 48,7 %; p < 0,001) und wurden seltener lysiert (17,9 vs. 42,5 %; p < 0,001). Insgesamt wurden häufiger Thrombozytenaggregationshemmer (ASS 93,4 vs. 89,4 %, Clopidogrel/Ticlopidin 63,6 vs. 36,8, p < 0,001) und unfraktioniertes Heparin (69,8 vs. 36,5, p < 0,001) eingesetzt, seltener niedermolekulare Heparine (31,1 vs. 51,2 %; p < 0,001). Bei Krankenhausentlassung wurden häufiger RAS- (80,2 vs. 66,6, p < 0,001) und Betablocker verwendet (87,4 vs. 78,8, p < 0,001) und seltener Lipidsenker (23,5 vs. 72,5 %; p < 0,001).

Schlussfolgerung: Die gegenwärtige Behandlung des akuten Koronarsyndroms im deutschen Cluster Detmold folgt weitgehend den Empfehlungen. Ansätze zur weiteren Optimierung liegen am ehesten in der Prähospitalphase, der häufigeren Verwendung von niedermolekularen Heparinen und dem konsequenteren Einsatz einer Pharmakotherapie zur Sekundärprävention.

Summary

Background: The acute coronary syndrome (ACS) remains a major cause of mortality and morbidity in the western world. The Global Registry of Acute Coronary Events (GRACE) documents inpatients with all types of ACS and a follow-up at three months in Germany and worldwide.

Methods: The data of the German Cluster Detmold were compared with data from the worldwide GRACE registry (31,070 patients). Data from 849 patients with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) were collected from October 2001 to September 2005 in eight participating hospitals in the GRACE2 Cluster Detmold.

Results: Compared with the worldwide GRACE data the patients in the Cluster Detmold had longer pre-hospital admission times (STEMI patients < 1 h: 13.9 % vs. 17.0 %; p < 0.05); more frequent interventions (PCI 60.1 % vs. 48.7%; p < 0.001) and less thrombolysis (17.9 vs. 42.5%; p < 0.001) in STEMI patients; more frequent use of platelet inhibitors (clopidogrel and ticlopidine, 93.4 % vs. 89.4%; p < 0.001) and unfractionated heparin (69.8 % vs. 36.5; p < 0.001), and less frequent use of low molecular weight heparin (31.1 % vs. 51.2%; p < 0.001); more frequent use of RAS blocking agents (80.2 vs. 66.6, p < 0.001) and beta blockers (87.4 vs. 78.8, p < 0.001) and less frequent use of lipid lowering agents (23.5 vs. 72.5%; p < 0.001).

Conclusions: Current management of ACS in Germany closely follows the recommendations of the German society of Cardiology. Differences in practice may account for the observed substantially lower event rates in Germany during hospitalization, but there is still room for improvement in the pre-hospital phase und in the degree to which pharmacotherapy is used for secondary prevention.

Schlüsselwörter

prospektives Register - akutes Koronarsyndrom - STEMI - NSTEMI - Antikoagulation

Key words

prospective registry - acute coronary syndrome - STEMI - NSTEMI - anticoagulation

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