The choice of treatment options for patients with coronary artery disease is an issue that both doctors and patients struggle with. In short, whether we choose drugs, stents or bypasses, the only two purposes of treatment are to improve the quality of life and to live longer; whichever method is conducive to both longevity and quality of life should be chosen. Yao Yucai, Department of Cardiology, Shandong Qianfo Mountain Hospital
There are advantages and disadvantages of each of the three treatment methods: drug, stent and bypass. Drug treatment belongs to systemic treatment, while atherosclerosis belongs to systemic disease. Obviously, drug treatment is the basis of coronary heart disease treatment, because patients with coronary heart disease often have atherosclerotic changes in the blood vessels of cerebral vessels and other important organs such as kidneys, so while drug treatment treats coronary heart disease and controls coronary atherosclerosis, it can also effectively stop the progress of atherosclerosis in other important blood vessels. However, drug therapy cannot reverse severe coronary stenoses in the real world, such as vessels that have been completely occluded or stenoses that are more than 70% in diameter, and the current state of myocardial ischemia caused by these severe obstructions is difficult to be effectively relieved by drugs. In conclusion, drugs have a clear advantage in combating systemic atherosclerosis, but are powerless in reversing severe localized stenoses. Stents and bypasses are local treatments that are ineffective in the progression of systemic atherosclerosis but can change the status quo of severe localized stenosis of blood vessels. Stents more often address a single lesion, while bypasses more often address a single vessel, so bypasses address stenosis somewhat more completely than stents.
As drugs, stents, and bypasses all continue to evolve and progress, the indications for each are changing. Which method a specific patient should choose depends on a combination of factors such as the patient’s symptoms, extent of myocardial ischemia, cardiac function, characteristics of the vascular lesion, presence of diabetes, presence of renal insufficiency and other special diseases, the patient’s personal wishes and economic conditions, and the level of cardiology stent treatment and cardiac surgery bypass treatment.
In general, drug therapy is suitable for asymptomatic or CCS class I or II patients without evidence of large myocardial ischemia, as well as those with secondary branch lesions and lesions less than 50%. Stenting is suitable for patients with moderate or greater myocardial ischemia or evidence of surviving myocardium, single or double branch lesions with anterior descending branch lesions, those who can achieve complete revascularization, those with limited involvement of all three vessels, and those with acute coronary syndromes, especially acute infarction. Bypass therapy is suitable for multiple lesions with LVEF <40%, PC It is also suitable for patients with multiple lesions with LVEF less than 40%, PC I who cannot be completely revascularized, multiple diffuse lesions especially in the presence of diabetes mellitus, left main trunk lesions or anterior descending branch openings with multiple lesions, etc. Revascularization must be combined with pharmacological treatment to achieve a perfect therapeutic effect.