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Notfall + Rettungsmedizin
Erschienen in:

01.11.2008 | Leitthema

Vorgehen bei STEMI/NSTEMI nach Reanimation

verfasst von: Prof. Dr. P. Eisenburger

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 7/2008

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Zusammenfassung

Hintergrund

Die Therapie eines Myokardinfarktes mit ST-Streckenhebungen (STEMI) nach Kreislaufstillstand mit primär erfolgreicher Reanimation ist nicht klar etabliert. Es gibt die Option des konservativen Abwartens, der systemischen Thrombolyse und der primären perkutanen koronaren Intervention (PPCI). Welches der Therapiekonzepte das beste Langzeitergebnis hervorbringt, ist bislang unklar. In der vorliegenden Arbeit werden bisherige Berichte analysiert. Es werden das gesamte Überleben einerseits und neurologisch intaktes Überleben andererseits sowie Komplikationen (z. B. Blutungen) evaluiert.

Ergebnisse

Als Resultat zeigt sich eine höhere Rate an Überleben bei der PPCI (61%) im Vergleich zur Thrombolyse (54%). Das neurologisch intakte Langzeitüberleben (>6 Monate mit Cerebral Performance Category 1 oder 2) ist bei der Thrombolyse mit 54% besser als bei der PPCI (49%). Die konservative Therapie ohne Rekanalisation ist in beiden Aspekten schlechter (40% bzw 37%). Blutungen spielen keine relevante Rolle und verschlechtern nicht das Überleben, auch wenn therapeutische Hypothermie eingesetzt wird.

Schlussfolgerungen

Systemische Thrombolyse bei Patienten nach erfolgreicher Reanimation bei STEMI führt zu einer höheren Rate von Patienten mit neurologisch intaktem Überleben verglichen mit PPCI bzw. mit konservativer Therapie ohne Reperfusion.
Vorheriger Artikel Versorgung nach Reanimation
Nächster Artikel Therapeutische Hypothermie
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Metadaten
Titel
Vorgehen bei STEMI/NSTEMI nach Reanimation
verfasst von
Prof. Dr. P. Eisenburger
Publikationsdatum
01.11.2008
Verlag
Springer-Verlag
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 7/2008
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-008-1069-x

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