Indications for coronary artery stenting

  I. Most patients with asymptomatic myocardial ischemia or mild angina and at high risk of significant ischemia confirmed by platelet exercise test or 24-hour ambulatory electrocardiogram (Holter) monitoring should be considered for coronary stenting as an option in order to maintain their physical activity and participation in physical exercise, improve their work and quality of life, and reduce the risk of serious or fatal cardiac events, if there are severe lesions on coronary angiography. This group of patients has a high success rate and a low rate of disability or death.  Second, angina: Many patients with moderate to severe stable angina or unstable angina do not respond well to medications and are usually candidates for coronary stenting. Most patients in this category have single or multiple coronary lesions, with a high success rate, low risk, and significant postoperative angina relief.  Third, myocardial infarction: Acute myocardial infarction is caused by severe reduction and sudden cessation of myocardial blood flow, and the most common cause is atherosclerosis of the major coronary arteries and thrombus occlusion. Coronary intervention is a very effective means of reestablishing coronary perfusion and is suitable for 90% of patients with acute myocardial infarction. Intracoronary stenting can further expand the results of coronary interventions. This approach yields immediate results in the treatment of acute myocardial infarction, allowing more myocardium to be protected, less time for myocardial ischemia, and more benefit to the patient.  Advantages and disadvantages of coronary stenting: The advantages of coronary intervention are the relative ease of application, avoidance or reduction of general anesthesia, open heart, extracorporeal circulation, central nervous system complications, and recovery time. Repeat coronary intervention is easier to perform than repeat coronary artery bypass grafting. Moreover, it can achieve rapid hemodialysis in emergency situations. With the continuous updating and improvement of interventional materials and the experience of surgeons, its safety and long-term results are getting significantly improved. Death or serious cardiac ischemic events are significantly reduced compared to drug therapy.  However, coronary stents also have their shortcomings and limitations, and coronary artery bypass grafting may be a better option for patients with multiple diffuse lesions and severely impaired cardiac function. In any case, various trials have shown that coronary stenting can result in significant relief of angina symptoms, increased exercise tolerance, and improved quality of life in patients with single or multiple coronary lesions. Coronary stenting is more likely to be performed in those patients with severe symptoms of myocardial ischemia and in symptomatic patients who wish to maintain physical activity.