Revaskularisation versus konservative Therapie der stabilen koronaren Herzerkrankung – Neue Betrachtungen nach COURAGE und BARI 2D

Dieser Übersichtsartikel befasst sich mit den Therapieoptionen bei Patienten mit stabiler koronarer Herzerkrankung (KHK). Innerhalb der letzten Jahre sind einige große Studien zu diesem Thema publiziert worden, welche eine Revaskularisationstherapie mit einer alleinigen medikamentösen Therapie randomisiert verglichen haben. Es existieren ebenfalls Metaanalysen, welche die Ergebnisse der Studien der letzten 10 Jahre zum Thema konservative Therapie versus Revaskularisation bei Patienten mit stabiler KHK analysieren. Eine der größten Studien auf diesem Gebiet ist die COURAGE–Studie, welche gezeigt hat, dass eine interventionelle Therapie der stabilen KHK keinen Vorteil im Vergleich zur konservativen Therapie hinsichtlich des kombinierten Endpunktes aus Tod und Myokardinfarkt mit sich bringt. Dieses Studienergebnis konnte durch Metaanalysen bestätigt werden. Bei Patienten mit Diabetes mellitus und manifester KHK konnte in der BARI 2D–Studie ebenfalls kein Vorteil einer interventionellen Therapie gesehen werden.

This review focuses on the current therapeutic approaches for patients with stable coronary artery disease. In the past two to three years several large randomized trials comparing revascularization therapy to medical therapy alone – e.g. COURAGE trial and BARI 2D trial – have been published. In addition several metaanalyses with respect to this topic have been published recently. The COURAGE study showed no advantage of an interventional regimen compared to medical therapy with respect to a combined endpoint of death and myocardial infarction. Several metaanalyses performed came to a similar conclusion; PCI did not prove to be superior to conservative treatment in patients with stable coronary artery disease when considering the above mentioned endpoints. The authors of the BARI 2D trial also confirmed this finding; they found that patients suffering coronary artery disease and concomitant diabetes will not have an advantage from an interventional approach in comparison to a conservative approach.

Key words

Stent - revascularization - coronary artery disease - medical treatment

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