Nearly 300 million people in China suffer from cardiovascular disease, with more than 3 million deaths per year, of which coronary heart disease is the most important factor. Drug therapy, coronary artery bypass grafting (CABG) and interventional therapy (PCI) are the three “carriages” of coronary heart disease treatment. Interventional therapy has rapidly gained popularity over the past 30 years and has become an effective and rapid treatment method to relieve angina pectoris and reduce mortality from acute myocardial infarction. Statistics show that in 2013, more than 400,000 cases of coronary heart disease were treated with intervention in China, and the annual growth rate is 15% to 30%. Facing this new huge population of coronary heart disease, how to effectively prevent their cardiovascular events has become a challenge in the field of modern coronary heart disease.
I. Which coronary heart disease population is suitable for interventional treatment?
1, chronic stable angina: stable angina is a common type of coronary heart disease, mainly manifested as regular episodes of angina, often triggered by exercise, emotional excitement, etc., and the trigger, duration, nature of pain and location of each attack basically do not change. Interventional treatment for stable angina aims to improve myocardial ischemia and relieve patients’ symptoms, but some clinical studies have demonstrated that interventional treatment does not improve the long-term prognosis of patients with mild to moderate stable angina. Therefore, for patients with mild or moderate stable angina, drug therapy should be considered first; for patients with severe stable angina, patients whose quality of life is seriously affected or patients whose angina attacks cannot be controlled by drug therapy, interventional therapy should be considered.
2, unstable angina: mainly including.
(1) the first attack of angina pectoris, and more pain is heavy, containing nitroglycerin is difficult to quickly relieve;
(2) on the basis of chronic stable angina, the number of episodes of angina has increased significantly in the last month, the duration of the episodes is significantly longer, and the degree of pain is significantly worse than before;
(3) Angina pectoris attacks at rest, quiet state, generally longer duration;
(4) Angina pectoris that occurs 24 hours after the onset of acute myocardial infarction to within 1 month. All of the above types are unstable angina, and in the absence of contraindications, interventional treatment should be performed when drug therapy is ineffective or ineffective. Coronary intervention can reduce the occurrence of cardiovascular events in patients with unstable angina, improve the quality of patient survival and improve the prognosis.
3, acute myocardial infarction: acute myocardial infarction is divided into acute ST-segment elevation myocardial infarction (STEMI) and acute non-ST-segment elevation myocardial infarction (NSTEMI) according to whether the ST segment is elevated on the ECG during the attack. NSTEMI patients, if the condition is stable and there is no obvious hemodynamic changes, elective coronary intervention can reduce the occurrence of intervention-related complications; if the patient is hemodynamically unstable, due to myocardial ischemic necrosis leading to heart failure or cardiogenic shock, etc., then urgent coronary intervention is required.
Second, the problems after interventional treatment
Many patients think that interventional therapy is a “radical” coronary artery disease procedure and can solve coronary artery disease once and for all, which is one of the most common misconceptions. With the continuous development of coronary interventional technology, the emergence of new drug-coated stents, biodegradable drug-coated stents and drug-eluting balloons, the postoperative complications are gradually reduced, but complications such as in-stent restenosis and stent thrombosis are still serious problems that need to be faced clinically.
1. After stent restenosis after interventional treatment coronary stent implantation, in-stent restenosis occurs in some patients due to local inflammatory reaction, proliferation of vascular endothelium, vascular remodeling and other reasons. Although the application of new drug-eluting stents has reduced the incidence of in-stent restenosis, the incidence of stent restenosis is still around 3%-9% at 6 months postoperatively.
2, coronary artery in-stent thrombosis After coronary stent implantation, some patients may be at risk of in-stent thrombosis because of antiplatelet drug resistance (aspirin resistance, clopidogrel resistance), structural and functional damage to endothelial cells after stent implantation, and high local thrombus load. At present, thromboelastography can detect the related risks in time, provide reference basis for drug adjustment and reduce the risk of in-stent thrombosis.
3.No recurrent flow after stent implantation For patients with acute myocardial infarction, during emergency intervention, due to factors such as abnormal coagulation mechanism, fibrinolytic system disorder, platelet activation, vascular endothelial dysfunction and atherosclerotic plaque fragment to the distal end of the vessel in the patient’s body, resulting in slowed perfusion or even no blood flow at the myocardial tissue level after stenosis lifting. No-reflow is a serious complication of interventional procedures and a major risk factor affecting patient prognosis.
4, psychological barriers before and after interventional surgery At present, there are about 500,000 patients with coronary heart disease stent implantation in China every year. According to relevant studies, it is found that some patients will experience significant anxiety or depression before and after intervention, which is increasingly causing clinical concern. Patients experience the dual psychological stress of surgery and the underlying disease, and the incidence of anxiety and depression increases and is reported to be up to 30% or more. This adverse psychological response can directly affect the patient’s postoperative health recovery and is currently a risk factor for the occurrence of adverse cardiovascular events after interventional procedures.
Third, post-interventional drug therapy
1, Western drug treatment after interventional surgery routine use of dual antiplatelet therapy, the need to take two antiplatelet drugs, such as no adverse reactions and obvious contraindications, aspirin needs to be taken for life. In addition to aspirin, another antiplatelet drug needs to be added, which is currently commonly used as clopidogrel, and newer antiplatelet drugs such as tigretol, which further reduces the risk of stent thrombosis. The current duration of duplex antiplatelet therapy is generally 3 months after bare metal stent implantation and 12 months after drug-eluting stent implantation.
Statin lipid-lowering drugs are long-term drugs to be taken after interventional procedures, and patients have some misconceptions about these drugs: some people stop taking them after their blood lipids are checked to be “normal”, which is a big mistake. On the one hand, the lipid level of patients with coronary heart disease is different from normal people, so even if the lipid level is “normal”, they still need to take these drugs for a long time unless in special circumstances; on the other hand, these drugs also have the effect of stabilizing plaque and reducing inflammation, which can improve the prognosis of cardiovascular disease. Statin lipid-lowering drugs mainly include simvastatin, resulvastatin, atorvastatin calcium and so on. In addition, RASS system blockers and beta-blockers are also important drugs for the treatment of coronary heart disease, especially for patients with myocardial infarction; however, not all patients need or can tolerate such drugs. For this reason, they need to be taken according to medical advice. Commonly used drugs such as captopril, fosinopril, cloxacin, irbesartan, metoprolol, bisoprolol, etc.
2, Chinese herbal medicine treatment Chinese medicine, especially blood-stasis-activating herbal medicine, has shown better effects on patients after coronary intervention: for example, blood-stasis-activating herbal medicine can significantly improve myocardial blood supply and reduce restenosis after stenting in patients with coronary heart disease; after combined application with western medicine, it can not only reduce the incidence of cardiovascular events, but also does not increase the risk of reducing bleeding and reducing gastric mucosal damage by western medicine. Therefore, on the basis of conventional treatment with western drugs, combining with reasonable herbal treatment is an option to further improve the prognosis of patients. For those who cannot take Chinese herbal soup due to the patient’s own condition or medical condition, Chinese patent medicine treatment can be considered. At present, there are hundreds of proprietary Chinese medicines listed for the treatment of coronary heart disease, with different indications. Patients should choose the proprietary Chinese medicines suitable for themselves according to their own conditions and under the guidance of doctors, and should not blindly believe in advertising and other people’s experience in taking medicines.
Regular follow-up is a fundamental part of improving prognosis
The doctor will review the relevant tests and adjust the dosage of drugs according to the individual patient’s condition. It should be noted that the dose of medication for many patients with coronary artery disease is not fixed, and the prescription of Chinese medicine needs to change more with the change of symptoms and and time. Drug doses, changes in blood pressure, changes in lifestyle habits and changes in blood sugar may all have an impact on the organism and should be monitored on a follow-up basis, but should be implemented under the guidance of a physician and should not blindly change the type and and dose of drugs at will according to changes in symptoms.
V. Health is in your own hands
Healthy lifestyle is the cornerstone of improving the prognosis of post-interventional coronary heart disease patients, and all drug treatment should be based on a healthy lifestyle, specifically the following aspects.
1, exercise: post-interventional patients have different tolerances for exercise, which are related to heart function, degree of stenosis, stent opening and so on. Some patients can gradually return to a normal healthy state, while others may not return to the original level, which requires adjusting the amount of exercise according to the doctor’s recommendations, and not a sudden increase in exercise in a short period of time.
2, diet: should follow the principle of “low salt and low fat”, more fresh vegetables, fruits, fish, soy products and dairy products, etc., should not eat animal offal and other high-fat, high cholesterol food. At the same time should also limit alcohol intake.
3, quit smoking: smoking as an independent risk factor for cardiovascular disease, not only can accelerate the process of atherosclerosis, but also directly lead to coronary artery damage, spasm, etc.. Therefore, patients with coronary heart disease, especially post-interventional patients must quit smoking.
4, weight control: hypertension, diabetes, hyperlipidemia, can be secondary to obesity. Using weight (kg)/height (m)2, calculate the body mass index (BMI), the normal value is 18.5-23.9, >24 is called overweight, >28 is called obese. If there is overweight and obesity, it is necessary to lose weight.
5, maintain optimistic mood: some patients with coronary artery disease after intervention will combine psychological problems, including anxiety, depression, etc. Bad mood may aggravate and induce myocardial ischemic attack, so it is important to maintain an optimistic mood. You can keep your emotions comfortable and relax your tension by cultivating healthy hobbies such as painting, calligraphy, carving, etc.
6.Monitoring blood pressure and controlling blood sugar: After coronary intervention, you need to control blood pressure and blood sugar at the same time, and you cannot neglect these links. Otherwise, it will lead to the occurrence of cardiovascular disease events.
7, do not overly believe in nutritional supplements: with the popularity of various information technology, patients with coronary heart disease are exposed to more and more information, and in order to attract people’s attention, some advertisements over-exaggerate the effect and mislead consumption. Most health care products have no exact efficacy on the disease, and even improperly taken will also produce adverse reactions, delaying the disease, further damaging the health of patients and causing irreparable physical and economic losses to patients.