Leitfaden Herzkatheter

Postoperative Care and Follow-Up After Coronary Stenting

“…The probability that CHD is present and needs treatment can be estimated on the basis of the totality of the patient's clinical findings. History taking and physical examination, including an assessment of cardiovascular risk factors and of evidence of myocardial ischemia, constitute the best way of detecting possible progression of coronary heart disease and determining whether coronary angiography should be per formed (3,14,15). The indication for coronary angiography also depends on the patient's overall state of health and on whether he or she would consent to interventions that might be recommended on the basis of the results (e.g., a stent placement or bypass operation).…”

“…Such decisions should be made on a case-by-case basis, with the involvement of the treating primary care physician/ internist and the cardiologist. Angiography is particularly useful when the symptoms have no clearly identifiable, non-cardiac cause, when the previous findings were not completely normal, or when the patient is severely distressed by anxiety about heart disease (14).…”

“…If the patient has no more than mild or atypical anginal symptoms, non-invasive studies should be done first. These will serve to identify patients at high risk, who should then undergo diagnostic cardiac catheterization (2,14).…”

“…Moreover, an interventional treatment of a non-flow-limiting in-stent stenosis retriggers the remodeling process and might, therefore, actually lead to a worse result. While uncontrolled studies suggest (as such studies often do) a survival advantage (14) for patients undergoing routine follow-up angiography after balloon dilatation (e1) or stent implantation (e2), randomized controlled trials (e3) show that routine follow-up angiography merely increases the number of interventions to treat irrelevant coronary stenoses, without any improvement of outcome.…”