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Aktuelle Kardiologie 2017; 6(05): 355-360
DOI: 10.1055/s-0043-120267
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Multivessel vs. Culprit-Lesion-Stenting beim akuten Koronarsyndrom

Multivessel vs. Culprit Vessel Percutaneous Coronary Intervention in Acute Coronary Syndrom
Oliver Dörr
1   Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen und Marburg, Standort Gießen
,
Christian W. Hamm
2   Herz und Thorax Zentrum, Kerckhoff-Klinik, Bad Nauheim
,
Holger Nef
1   Medizinische Klinik I, Abteilung für Kardiologie, Universitätsklinikum Gießen und Marburg, Standort Gießen
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Publication History

Publication Date:
13 November 2017 (online)

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Zusammenfassung

Bei Patienten mit akutem Koronarsyndrom (ACS) kann durch die Koronarangiografie in bis zu 50% der Fälle eine koronare Mehrgefäßerkrankung nachgewiesen werden, sodass die interventionelle Behandlung dieser Patienten im klinischen Alltag häufig eine Herausforderung darstellt. In einigen randomisierten Studien konnte der Vorteil einer kompletten Revaskularisation bei Patienten mit akutem ST-Hebungsinfarkt nachgewiesen werden (PRAMI, CvLPRIT, Compare-Acute und DANAMI-3-PRIMULTI). Bei Patienten mit Nicht-ST-Hebungs-ACS und koronarer Mehrgefäßerkrankung konnte ebenfalls der Vorteil einer kompletten Revaskularisation gezeigt werden. Sprechen die Ergebnisse dieser Studien auch für die Complete-PCI gegenüber einer Culprit-only-PCI, so fehlen allerdings bisher genaue Empfehlungen bezüglich des optimalen zeitlichen Vorgehens im Sinne einer Staged-PCI. Auch die Komplexität der koronaren Herzerkrankung wird häufig nicht hinreichend berücksichtigt.

Abstract

Primary percutaneous intervention (PCI) is the treatment of choice for ST-segment elevation myocardial infarction (STEMI). Patients with acute coronary syndrome often have obstructive non-culprit lesions. However, current guidelines do not recommend revascularization of non-culprit lesions unless complicated by cardiogenic shock. Recent randomized studies (PRAMI, CvLPRIT, Compare-Acute and DANAM-3-PRIMULTI) provide data that suggest potential benefit with complete revascularization in STEMI patients with obstructive non-culprit lesions. In patients with NSTE-ACS identification of the culprit lesion by angiography alone is often challenging. The results from the current randomized SMILE Study indicate the superiority of complete PCI when compared with culprit only PCI. However, the optimal time point of the staged PCI and the complexity of the coronary artery disease were not adequately considered in these trials.

Schlüsselwörter

Multivessel PCI - Culprit-only PCI - akutes Koronarsyndrom

Key words

acute coronary syndrome - multivessel PCI - culprit only PCI
 

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