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Erschienen in: Die Innere Medizin 9/2008

01.09.2008 | Schwerpunkt

Therapie des akuten Myokardinfarkts in der Prähospitalphase

verfasst von: Prof. Dr. H.R. Arntz

Erschienen in: Die Innere Medizin | Ausgabe 9/2008

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Zusammenfassung

Die Prähospitalphase des akuten Myokardinfarkts ist entscheidend für die Prognose des Patienten. Einerseits besteht die Gefahr des plötzlichen Herztods durch Kammerflimmern, andererseits können bei Einschaltung des Rettungsdienstes bereits frühzeitig die Weichen für eine optimale Reperfusionsstrategie gestellt werden. Das durch große randomisierte Studien und Register gesicherte breite Spektrum therapeutischer Möglichkeiten hinsichtlich Thrombolyse, Thrombozytenhemmung und Antikoagulation sollte in diese Entscheidung ebenso eingehen wie die Patientenbedingungen, die Logistik und Zeitschienen sowie die verfügbaren lokalen Ressourcen.
Literatur
1.
Zurück zum Zitat Antman EM, Hand M, Armstrong PW et al. (2008) 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. Circulation 117: 296–329PubMedCrossRef Antman EM, Hand M, Armstrong PW et al. (2008) 2007 Focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. Circulation 117: 296–329PubMedCrossRef
2.
Zurück zum Zitat Antman EM, Morrow DA, McCabe CH et al. (2006) Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 354: 1477–1488PubMedCrossRef Antman EM, Morrow DA, McCabe CH et al. (2006) Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 354: 1477–1488PubMedCrossRef
3.
Zurück zum Zitat Armstrong PW, WEST Steering Committee (2006) A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST which early ST-elevation myocardial infarction therapy study. Eur Heart J 27: 1530–1538PubMedCrossRef Armstrong PW, WEST Steering Committee (2006) A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST which early ST-elevation myocardial infarction therapy study. Eur Heart J 27: 1530–1538PubMedCrossRef
4.
Zurück zum Zitat ASSENT-3 Study Group (2001) Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet 358: 605–613CrossRef ASSENT-3 Study Group (2001) Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet 358: 605–613CrossRef
5.
Zurück zum Zitat Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators (2006) Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 367: 569–578CrossRef Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators (2006) Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 367: 569–578CrossRef
6.
Zurück zum Zitat Breckwoldt J, Müller D, Overbeck M et al. (2008) Prehospital care of acute coronary syndrome by anaesthetists: Prospective comparison with the care standards of cardiologists. Anaesthesist 57: 131–138PubMedCrossRef Breckwoldt J, Müller D, Overbeck M et al. (2008) Prehospital care of acute coronary syndrome by anaesthetists: Prospective comparison with the care standards of cardiologists. Anaesthesist 57: 131–138PubMedCrossRef
7.
Zurück zum Zitat Canto JG, Rogers WJ, Bowlby LJ (1997) The prehospital electrocardiogram in acute myocardial infarction: is its full potential beeing realized? J Am Coll Cardiol 29: 498–505PubMedCrossRef Canto JG, Rogers WJ, Bowlby LJ (1997) The prehospital electrocardiogram in acute myocardial infarction: is its full potential beeing realized? J Am Coll Cardiol 29: 498–505PubMedCrossRef
8.
Zurück zum Zitat Chen ZM, Jiang LX, Chen YP et al. (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366: 1607–1621PubMedCrossRef Chen ZM, Jiang LX, Chen YP et al. (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366: 1607–1621PubMedCrossRef
9.
Zurück zum Zitat GISSI-Avoidable Delay Study Group (1995) Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. A GISSI-generated study. Arch Intern Med 155: 1481–1488CrossRef GISSI-Avoidable Delay Study Group (1995) Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. A GISSI-generated study. Arch Intern Med 155: 1481–1488CrossRef
10.
Zurück zum Zitat Gyongyosi M, Domanovits H, Benzer W et al. (2004) Use of abciximab prior to primary angioplasty in STEMI results in early recanalization of the infarct-related artery and improved myocardial tissue reperfusion – results of the Austrian multi-centre randomized ReoPro-BRIDGING Study. Eur Heart J 25: 2125–2133PubMedCrossRef Gyongyosi M, Domanovits H, Benzer W et al. (2004) Use of abciximab prior to primary angioplasty in STEMI results in early recanalization of the infarct-related artery and improved myocardial tissue reperfusion – results of the Austrian multi-centre randomized ReoPro-BRIDGING Study. Eur Heart J 25: 2125–2133PubMedCrossRef
11.
Zurück zum Zitat Hamm C, Arntz HR, Bode C et al. (2004) Leitlinien: Akutes Koronarsyndrom (ACS). Teil 2: ACS mit ST-Hebung. Z Kardiol 93: 324–341PubMedCrossRef Hamm C, Arntz HR, Bode C et al. (2004) Leitlinien: Akutes Koronarsyndrom (ACS). Teil 2: ACS mit ST-Hebung. Z Kardiol 93: 324–341PubMedCrossRef
12.
Zurück zum Zitat ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (1988) Randomised trial of intravenous streptokinase, oral aspirin, both or neither among 17.187 cases of suspected acute myocardial infarction: ISIS-2. Lancet II: 349–360 ISIS-2 (Second International Study of Infarct Survival) Collaborative Group (1988) Randomised trial of intravenous streptokinase, oral aspirin, both or neither among 17.187 cases of suspected acute myocardial infarction: ISIS-2. Lancet II: 349–360
13.
Zurück zum Zitat Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361: 13–20PubMedCrossRef Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361: 13–20PubMedCrossRef
14.
Zurück zum Zitat Löwel H, Meisinger C, Heier M, Hörmann A (2005) The population-based acute myocardial infarction (AMI) registry of the MONICA/KORA study region of Augsburg. Gesundheitswesen 67 (Sonderheft 1): 31–37CrossRef Löwel H, Meisinger C, Heier M, Hörmann A (2005) The population-based acute myocardial infarction (AMI) registry of the MONICA/KORA study region of Augsburg. Gesundheitswesen 67 (Sonderheft 1): 31–37CrossRef
15.
Zurück zum Zitat Montalescot G, Sideris G, Meuleman C et al. (2006) A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. J Am Coll Cardiol 48: 931–938PubMedCrossRef Montalescot G, Sideris G, Meuleman C et al. (2006) A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the Best Loading Dose of Clopidogrel to Blunt Platelet Activation, Inflammation and Ongoing Necrosis) trial. J Am Coll Cardiol 48: 931–938PubMedCrossRef
16.
Zurück zum Zitat Müller D, Agrawal R, Arntz HR (2006) How sudden is sudden cardiac death? Circulation 114: 1146–1150PubMedCrossRef Müller D, Agrawal R, Arntz HR (2006) How sudden is sudden cardiac death? Circulation 114: 1146–1150PubMedCrossRef
17.
Zurück zum Zitat Nallamothu BK, Bates ER, Herrin J et al. (2005) Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation 111: 761–767PubMedCrossRef Nallamothu BK, Bates ER, Herrin J et al. (2005) Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation 111: 761–767PubMedCrossRef
18.
Zurück zum Zitat Pinto DS, Kirtane AJ, Nallamothu BK et al. (2006) Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 114: 2019–2025PubMedCrossRef Pinto DS, Kirtane AJ, Nallamothu BK et al. (2006) Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 114: 2019–2025PubMedCrossRef
19.
Zurück zum Zitat Recio-Mayoral A, Kaski JC, McMurray JJV et al. (2007) Clinical trials update from the ESC Congress in Vienna 2007: PROSPECT, EVEREST, ARISE, ALOFT, FINESSE, PRAGUE-8, CARESS in MI and ACUITY. Cardiovasc Drugs Ther 21: 459–465PubMedCrossRef Recio-Mayoral A, Kaski JC, McMurray JJV et al. (2007) Clinical trials update from the ESC Congress in Vienna 2007: PROSPECT, EVEREST, ARISE, ALOFT, FINESSE, PRAGUE-8, CARESS in MI and ACUITY. Cardiovasc Drugs Ther 21: 459–465PubMedCrossRef
20.
Zurück zum Zitat Sabatine MS, Cannon CP, Gibson CM et al. (2005) Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 352: 1179–1189PubMedCrossRef Sabatine MS, Cannon CP, Gibson CM et al. (2005) Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 352: 1179–1189PubMedCrossRef
21.
Zurück zum Zitat Sabatine MS, Cannon CP, Gibson CM et al. (2005) Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA 294: 1224–1232PubMedCrossRef Sabatine MS, Cannon CP, Gibson CM et al. (2005) Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA 294: 1224–1232PubMedCrossRef
22.
Zurück zum Zitat Sabatine MS, Morrow DA, Dalby A et al. (2007) Efficacy and safety of enoxaparin versus unfractionated heparin in patients with ST-segment elevation myocardial infarction also treated with clopidogrel. J Am Coll Cardiol 49: 2256–2263PubMedCrossRef Sabatine MS, Morrow DA, Dalby A et al. (2007) Efficacy and safety of enoxaparin versus unfractionated heparin in patients with ST-segment elevation myocardial infarction also treated with clopidogrel. J Am Coll Cardiol 49: 2256–2263PubMedCrossRef
23.
Zurück zum Zitat Schuchert A, Hamm CW, Scholz J et al. (1999) Prehospital testing for troponin T in patients with suspected acute myocardial infarction. Am Heart J 138: 45–4813PubMedCrossRef Schuchert A, Hamm CW, Scholz J et al. (1999) Prehospital testing for troponin T in patients with suspected acute myocardial infarction. Am Heart J 138: 45–4813PubMedCrossRef
24.
Zurück zum Zitat Stenestrand U, Lindback J, Wallentin L RIKS-HIA Registry (2006) Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296: 1749–1756PubMedCrossRef Stenestrand U, Lindback J, Wallentin L RIKS-HIA Registry (2006) Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296: 1749–1756PubMedCrossRef
25.
Zurück zum Zitat The OASIS-6 Trial Group (2006) Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA 295: 1519–1530CrossRef The OASIS-6 Trial Group (2006) Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA 295: 1519–1530CrossRef
26.
Zurück zum Zitat van’t Hof AW, Ernst N, de Boer MJ et al. (2004) Facilitation of primary coronary angioplasty by early start of a glycoprotein 2b/3a inhibitor: results of the ongoing tirofiban in myocardial infarction evaluation (On-TIME) trial. Eur Heart J 25: 837–846CrossRef van’t Hof AW, Ernst N, de Boer MJ et al. (2004) Facilitation of primary coronary angioplasty by early start of a glycoprotein 2b/3a inhibitor: results of the ongoing tirofiban in myocardial infarction evaluation (On-TIME) trial. Eur Heart J 25: 837–846CrossRef
27.
Zurück zum Zitat Wallentin L, Goldstein P, Armstrong PW et al. (2003) Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS randomized trial in acute myocardial infarction. Circulation 108: 135–142PubMedCrossRef Wallentin L, Goldstein P, Armstrong PW et al. (2003) Efficacy and safety of tenecteplase in combination with the low-molecular-weight heparin enoxaparin or unfractionated heparin in the prehospital setting: the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 PLUS randomized trial in acute myocardial infarction. Circulation 108: 135–142PubMedCrossRef
28.
Zurück zum Zitat Zeymer U, Arntz HR, Darius H et al. (2007) Efficacy and safety of clopidogrel 600 mg administered pre-hospitally to improve primary percutaneous coronary intervention in patients with acute myocardial infarction (CIPAMI): study rationale and design. Cardiology 108: 265–272PubMedCrossRef Zeymer U, Arntz HR, Darius H et al. (2007) Efficacy and safety of clopidogrel 600 mg administered pre-hospitally to improve primary percutaneous coronary intervention in patients with acute myocardial infarction (CIPAMI): study rationale and design. Cardiology 108: 265–272PubMedCrossRef
29.
Zurück zum Zitat Zeymer U, Zahn R, Schiele R et al. (2005) Early eptifibatide improves TIMI 3 patency before primary percutaneous coronary intervention for acute ST elevation myocardial infarction: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial. Eur Heart J 26: 1971–1977PubMedCrossRef Zeymer U, Zahn R, Schiele R et al. (2005) Early eptifibatide improves TIMI 3 patency before primary percutaneous coronary intervention for acute ST elevation myocardial infarction: results of the randomized integrilin in acute myocardial infarction (INTAMI) pilot trial. Eur Heart J 26: 1971–1977PubMedCrossRef
30.
Zurück zum Zitat Zijlstra F, Ernst N, de Boer MJ et al. (2002) Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction. J Am Coll Cardiol 39: 1733–1737PubMedCrossRef Zijlstra F, Ernst N, de Boer MJ et al. (2002) Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction. J Am Coll Cardiol 39: 1733–1737PubMedCrossRef
Metadaten
Titel
Therapie des akuten Myokardinfarkts in der Prähospitalphase
verfasst von
Prof. Dr. H.R. Arntz
Publikationsdatum
01.09.2008
Verlag
Springer-Verlag
Erschienen in
Die Innere Medizin / Ausgabe 9/2008
Print ISSN: 2731-7080
Elektronische ISSN: 2731-7099
DOI
https://doi.org/10.1007/s00108-008-2073-4

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