Prästationäre Diagnostik und Therapie des Akuten Koronarsyndroms – Kooperationen und Netzwerke zur gezielten Therapieeinleitung

Der akute Brustschmerz zählt zu einem der häufigsten Gründe einer prästationären Notfallversorgung. In 20–30 % der Fälle kann ein Akutes Koronarsyndrom (ACS) diagnostiziert werden. Anhand des EKGs, der Anamnese, der körperlichen Untersuchung sowie der Erhebung der Vitalparameter muss der Notarzt innerhalb von 10 Minuten eine Verdachtsdiagnose erstellen und eine Risikostratifizierung durchführen. Basierend auf der Evaluation im Rahmen des ersten medizinischen Kontakts (EMK) entscheidet sich das weitere logistische und therapeutische Vorgehen. Patienten mit einem ST-Streckenhebungsinfarkt (STEMI) sollten innerhalb den durch die Leitlinien definierten Zeitlimits einer geeigneten Reperfusionstherapie zugeführt werden. Nach aktueller Leitlinienempfehlung sollte eine durch ein erfahrenes Team durchgeführte Koronarangiografie mit Interventionsbereitschaft angestrebt werden. Patienten mit dem Verdacht auf ein ACS ohne ST-Elevation (NSTE-ACS) sind für weitere diagnostische und therapeutische Maßnahmen in die nächste Chest-Pain-Unit zu begleiten.

Acute-onset chest pain is one of the main causes for a medical emergency contact. About 20–30 % of patients with chest pain suffer from acute coronary syndromes (ACS). Immediate diagnostic work-up including clinical assessment, medical history, evaluation of vital signs and ECG, as well as early risk stratification are essential for the patients' prognosis. During the first medical contact (FMC) a working diagnosis should be made within 10 minutes. Based on this evaluation the patient should be directed to a further targeted treatment. Patients presenting with ischaemic symptoms and ST-segment (STEMI) elevation deserve a rapid reperfusion therapy with primary percutaneous coronary intervention being the first-line approach. Patients with the working diagnosis of a non-ST-elevation acute coronary syndrome (NSTE-ACS) should be admitted to a dedicated chest pain unit for further risk stratification and treatment.

Key words

Acute coronary syndrome - first medical contact - risk stratification - reperfusion therapy

• Literatur

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