Coronary heart disease is a cardiovascular disease with a high incidence in China and worldwide. It is treated by three main methods, one is drug therapy, the other is interventional therapy, and the third is coronary artery bypass surgery. Percutaneous coronary intervention (PCI) for coronary artery disease has undergone more than 30 years of development from the initial balloon dilatation and angioplasty to the subsequent bare metal stent implantation and then to the drug-eluting stent implantation in recent years, and PCI treatment has gradually become the main means of coronary artery disease treatment with its unique advantages of easy operation, small trauma and fast postoperative recovery.
A. Coronary angiography is the “gold standard” for the diagnosis of coronary artery disease
Clinically, some patients have frequent episodes of chest tightness, chest pain, “ST-T changes” in electrocardiogram, or heart ultrasound suggests ventricular wall motion disorder, and are diagnosed as coronary heart disease and receive coronary heart disease drug treatment, and some patients use a large number of various Chinese and Western medicine drugs for a long time. A considerable number of these patients were later confirmed to have completely normal coronary vessels or very slight lesions by coronary angiography, thus negating the diagnosis of coronary artery disease. Therefore, coronary angiography should be performed as much as possible to clarify the diagnosis of coronary artery disease regardless of the symptoms, ECG, cardiac ultrasound or other examinations suggesting the possibility of coronary artery disease. Especially for middle-aged and elderly patients with hypertension, diabetes, dyslipidemia, smoking, family history of coronary heart disease, and lack of exercise, coronary angiography is recommended once you find that you have chest discomfort or chest pain after activity or exertion.
Second, coronary angiography is not equal to “stenting”
Some patients have a misconception that coronary angiography is “stent placement”, so even if they need to perform coronary angiography to determine whether they have coronary heart disease, they refuse to undergo the test because they are afraid of “stent placement”. In fact, coronary angiography is only a test to determine the presence or absence of coronary artery disease and to clarify the extent, degree, and nature of coronary lesions and to guide the treatment plan (medication, stent placement, or surgical bypass). The test itself is very safe.
Which coronary heart patients need coronary intervention?
1, various types of unstable angina, moderate or severe chest pain, work and life restrictions, especially in the quiet state or at night often attack, anti-anginal drugs (nitroglycerin, metoprolol, etc.) treatment is not effective. If it is confirmed by coronary angiography that there is a single branch, or double branch, or three branches with severe stenosis, stenting is needed to improve myocardial blood supply, relieve angina and improve the quality of life.
2.Acute myocardial infarction is a kind of emergency disease with rapid onset and many changes in condition, which needs timely and proper management. Whether acute myocardial infarction requires interventional treatment depends on the patient’s condition, but also on the time of onset, the equipment conditions of the hospital and the level of coronary interventional technology. If the patient’s onset (after chest pain) is within 6 to 12 hours, “emergency PCI” can be performed to quickly open the coronary artery “occlusion” caused by thrombosis, restore the blood supply to the myocardium, rescue the ischemic damaged myocardium on the verge of necrosis, and limit the infarct area To maximize life saving and protect cardiac function.
3, acute myocardial infarction recovery, acute myocardial infarction, 2 weeks to 1 month after the onset of acute myocardial infarction or even within 3 months of the patient, the coronary angiography shows that the infarct area related artery occlusion or severe stenosis, especially those who have signs related to myocardial ischemia, PCI treatment is beneficial to prevent the infarct area expansion and expansion, ventricular remodeling and the occurrence of malignant arrhythmias, which is also conducive to improving the long-term prognosis of acute The long-term prognosis of patients with acute myocardial infarction is also improved.
4. Patients who have undergone PCI or coronary artery bypass grafting will have clinical manifestations if restenosis occurs, and PCI can be considered for such patients.
Ten things that we are most concerned about after “stenting
1.Will the heart stent fall off?
Once the stent is successfully placed in the coronary vessels, it will not be dislodged again, and it can participate in activities after the operation.
2.How long will the heart stent stay in the body?
The stent will remain in the body after it is inserted. About 4 weeks after the stent is inserted, the surface of the stent will be completely covered by the endothelium of the blood vessel and fused into a part of the vessel wall, playing the role of supporting the blood vessel, preventing stenosis and stabilizing plaque.
3.Will stents cause rejection in the body?
There is no obvious rejection reaction after stent placement in human body.
4.Why do I still have chest pain after stenting?
If angina pectoris is clearly present before the surgery and the coronary stenosis is confirmed by imaging, the angina pectoris is obviously relieved or disappears after stent placement. However, there are some patients whose preoperative chest pain is not caused by angina pectoris, i.e. not due to myocardial ischemia, so even if stenting is given, the chest pain cannot be relieved.
5.Can I do MRI, CT and other examinations after stent placement?
MRI is usually avoided within 8 weeks after the placement of stainless steel stents. There is no restriction on CT examination.
6.Can I pass airport security after stent placement?
Airport security has no effect on the stent and will not cause the metal detector to issue an alarm.
7.Do I need to take aspirin and clopidogrel for a long time after stent placement?
Aspirin should be taken for a long time and clopidogrel should be used for at least 1 year in principle (75mg/day).
8.Is coronary heart disease completely cured after stenting?
Stenting is only a treatment for coronary artery disease, targeting only the diseased local vessels. It plays an important role in relieving stenosis, restoring myocardial blood supply, relieving angina, improving quality of life and saving the lives of patients with acute myocardial infarction. The benefits of stenting are based on medication and lifestyle changes. Without these two foundations, postoperative patients will still be in critical condition, so in addition to continuing to take medication as prescribed, postoperative patients should start to develop and maintain a good lifestyle. In addition, coronary angiography should usually be repeated 6-8 months after stenting in order to understand the status of stent placement and any new lesions.
9.Why do I have to take a lot of medications after stenting?
Many patients who have undergone stenting think that stenting is a “cure” and that the disease is over once and for all. Therefore, many patients with coronary artery disease stop taking medication prematurely or use medication irregularly after surgery for one reason or another, which eventually leads to recurrence or aggravation of the disease. Therefore, strict and standardized drug therapy is still very important, including the control of various risk factors, active antiplatelet, statin lipid regulation, and the use of RAAS inhibitors and β-blockers. Only strict and standardized drug therapy can effectively prevent the occurrence of in-stent restenosis (reoccurrence of myocardial ischemia) or/and thrombus formation (leading to myocardial infarction or even death) in coronary arteries.
10. Does Chinese medicine benefit patients with coronary artery disease who have stents in place?
The answer is yes, while PCI focuses on the intervention of localized lesions in coronary arteries, TCM is good at overall regulation, giving full play to the therapeutic advantages of multi-target and multi-path interventions of TCM, which can be organically combined with modern medicine to slow down the disease progression and the formation of new vulnerable plaques. Several recent studies have confirmed the efficacy of TCM in improving restenosis, no-reflow and myocardial injury after PCI, such as Tongxinluo capsule, which can significantly reduce myocardial no-reflow, reduce infarct size and improve cardiac function, showing the clinical value of solving this world-wide problem.