Skip to main content
Top

2008 | OriginalPaper | Hoofdstuk

22 Instabiele angina pectoris en myocardinfarct zonder ST-elevatie op het ECG

Auteurs : Dr. R. J. De Winter, Prof.Dr. P. Sinnaeve

Gepubliceerd in: Cardiologie

Uitgeverij: Bohn Stafleu van Loghum

share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Samenvatting

Een acuut coronair syndroom zonder ST-elevatie is een werkdiagnose die bij opname wordt gesteld bij patiënten die zich presenteren met pijn op de borst van ischemische origine, maar bij wie geen sprake is van ST-elevatie op het ECG. Deze werkdiagnose kan worden gesteld op basis van het risicoprofiel van de patiënt (belaste familieanamnese en aanwezigheid van risicofactoren voor hart- en vaatziekten zoals roken, hypertensie, hypercholesterolemie, diabetes mellitus) en op basis van de anamnese, terwijl er geen ECG-afwijkingen zijn. Meestal zullen er echter wel afwijkingen op het ECG zichtbaar zijn, zoals horizontale of ‘downsloping’ ST-depressie of T-golfveranderingen. De afwijkingen nemen toe tijdens pijn en verminderen wanneer de pijnklachten afnemen, bijvoorbeeld na toediening van nitroglycerine sublinguaal. In tegenstelling tot het acute coronaire syndroom mét ST-elevatie, waarbij de infarctgerelateerde coronaire arterie volledig is afgesloten en er transmurale hartischemie aanwezig is, komt er meestal geen transmurale ischemie voor en is de coronaire arterie in de regel nog doorgankelijk. Meestal is er dan ook geen indicatie voor reperfusietherapie en is er meer tijd voor verdere diagnostiek en evaluatie van het effect van de ingestelde behandeling.
Literatuur
go back to reference Alpert JS, Thygesen K, on behalf of the Joint ESC/ACC Committee. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol. 2000;36:959–69. Alpert JS, Thygesen K, on behalf of the Joint ESC/ACC Committee. Myocardial infarction redefined: a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol. 2000;36:959–69.
go back to reference Alpert JS, Thygesen K. A call for universal definitions in cardiovascular disease. Circulation. 2006;114:757–8.PubMedCrossRef Alpert JS, Thygesen K. A call for universal definitions in cardiovascular disease. Circulation. 2006;114:757–8.PubMedCrossRef
go back to reference Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324;71–86. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324;71–86.
go back to reference Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al., CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706–17.PubMedCrossRef Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al., CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706–17.PubMedCrossRef
go back to reference Braunwald E, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction – summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol. 2002;40:1366–74.PubMedCrossRef Braunwald E, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction – summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Unstable Angina). J Am Coll Cardiol. 2002;40:1366–74.PubMedCrossRef
go back to reference Fox KA, Poole-Wilson P, Clayton TC, Henderson RA, Shaw TR, Wheatley DJ, et al. 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005;366:914–20.PubMedCrossRef Fox KA, Poole-Wilson P, Clayton TC, Henderson RA, Shaw TR, Wheatley DJ, et al. 5-year outcome of an interventional strategy in non-ST-elevation acute coronary syndrome: the British Heart Foundation RITA 3 randomised trial. Lancet. 2005;366:914–20.PubMedCrossRef
go back to reference Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000;102:118–22.PubMedCrossRef Hamm CW, Braunwald E. A classification of unstable angina revisited. Circulation. 2000;102:118–22.PubMedCrossRef
go back to reference Lagerqvist B, Husted S, Kontny F, Stahle E, Swahn E, Wallentin L. Fast Revascularisation during InStability in Coronary artery disease (FRISC-II) Investigators. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet. 2006;368:998–1004.PubMedCrossRef Lagerqvist B, Husted S, Kontny F, Stahle E, Swahn E, Wallentin L. Fast Revascularisation during InStability in Coronary artery disease (FRISC-II) Investigators. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet. 2006;368:998–1004.PubMedCrossRef
go back to reference Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002;23:1809–40. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2002;23:1809–40.
go back to reference Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, et aEn, Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the mediterranean basin in 2004. Eur Heart J. 2006;27:2285–93. Mandelzweig L, Battler A, Boyko V, Bueno H, Danchin N, Filippatos G, et aEn, Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the mediterranean basin in 2004. Eur Heart J. 2006;27:2285–93.
go back to reference Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293:2908–17.PubMedCrossRef Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293:2908–17.PubMedCrossRef
go back to reference Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al., Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–33.PubMedCrossRef Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al., Clopidogrel in Unstable angina to prevent Recurrent Events trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–33.PubMedCrossRef
go back to reference Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al., ACUITY Investigators. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–16.PubMedCrossRef Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al., ACUITY Investigators. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–16.PubMedCrossRef
go back to reference The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502.
go back to reference Winter RJ de, et al. Long term outcome of the ICTUS trial. Clinical Trials Update III. European Society of Cardiology Scientific Sessions. Barcelona 2006. Winter RJ de, et al. Long term outcome of the ICTUS trial. Clinical Trials Update III. European Society of Cardiology Scientific Sessions. Barcelona 2006.
go back to reference Winter RJ de, Windhausen F, Cornel JH, Dunselman PH, Janus CL, Bendermacher PE, et al., Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353:1095–104.PubMedCrossRef Winter RJ de, Windhausen F, Cornel JH, Dunselman PH, Janus CL, Bendermacher PE, et al., Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353:1095–104.PubMedCrossRef
go back to reference Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al., OASIS-6 Trial Group. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295:1519–30.PubMedCrossRef Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, et al., OASIS-6 Trial Group. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295:1519–30.PubMedCrossRef
Metagegevens
Titel
22 Instabiele angina pectoris en myocardinfarct zonder ST-elevatie op het ECG
Auteurs
Dr. R. J. De Winter
Prof.Dr. P. Sinnaeve
Copyright
2008
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-313-7029-0_22