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Akuter Myokardinfarkt: interventionelle Therapieoptionen

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Die Notfalltherapie bei akutem Myokardinfarkt

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Summary

The limited success of thrombolytic therapy and the high percentage of patients who have to be excluded from lysis has resulted in the alternative application of primary PTCA in acute myocardial infarction. Randomized studies so far available have shown a significant decrease of hospital mortality by primary PTCA as compared to thrombolysis. Adjuvant stent implantation and a wider administration of glycoprotein IIA/IIIB inhibitors may further reduce mortality. For logistic and financial reasons however, not all patients with acute myocardial infarction can benefit from this therapeutic approach in spite of the high density of health care in Germany. Primary PTCA in acute myocardial infarction should be left to experienced centres and investigators. Of utmost importance is a reduction of the present “onsetto-opening” times by information campaigns, an improved triage, use of transportation times for pre-hospital lysis and improved thrombolytic agents.

Zusammenfassung

Der limitierte Erfolg der Thrombolysetherapie und der hohe Prozentsatz von Patienten, die von einer Lysebehandlung aus- geschlossen werden müssen, hat zur alternativen Anwendung der primären PTCA bei akutem Myokardinfarkt geführt. Aus den bisher vorliegenden randomisierten Studien ergibt sich eine im Vergleich zur Thrombolyse signifikante Reduktion der Hospitalsterblichkeit durch primäre PTCA. Durch adjuvante Stent-Implantation und den breiteren Einsatz von Glycoprotein IIA/IIIB-Inhibitoren ist eine weitere Senkung der Sterblichkeit erreichbar. Eine flächendeckende Versorgung aller Patienten mit akutem Myokardinfarkt ist trotz der hohen Versorgungsdichte in der Bundesrepublik aus logistischen und finanziellen Gründen nicht zu verwirklichen. Die primäre PTCA beim akuten Myokardinfarkt sollte in den Händen erfahrener Zentren und Untersucher bleiben. Vordringlich ist eine Verkürzung der gegenwärtigen „onset-to-opening“-Zeiten durch Aufklärungskampagnen, eine bessere Triage, Nutzung der Transportzeiten für prästationäre Lyse und bessere Thrombolytika.

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  1. Kardiologische Klinik Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität, Georgstr. 11, D-32545, Bochum, Bad Oeynhausen, Deutschland

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Editors and Affiliations

  1. Klinikum Benjamin Franklin, Medizinische Klinik II, Hindenburgdamm 30, D-12200, Berlin, Germany

    H.-R. Arntz

  2. Städtisches Krankenhaus Hildesheim Medizinische Klinik I, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Weinberg 1, D-31134, Hildesheim, Germany

    H.-P. Schuster

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© 2000 Springer-Verlag Berlin Heidelberg

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Mannebach, H., Horstkotte, D. (2000). Akuter Myokardinfarkt: interventionelle Therapieoptionen. In: Arntz, HR., Schuster, HP. (eds) Die Notfalltherapie bei akutem Myokardinfarkt. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57713-0_10

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  • DOI: https://doi.org/10.1007/978-3-642-57713-0_10

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-7985-1247-4

  • Online ISBN: 978-3-642-57713-0

  • eBook Packages: Springer Book Archive

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