There are several colleagues, relatives and friends who have had heart stents put in, and it’s always hard to see them, and one colleague said he was cold-shouldered when he was hospitalized because he didn’t listen to the advice of the doctor in charge of putting in a stent …… What are the circumstances under which a stent should be placed? Perhaps the following article is a bit instructive …… “China’s cardiac stent abuse is serious and can lead to acute myocardial infarction” Half of the cardiac stents “non-essential” March 10, the most authoritative international clinical medical journal – the United States “New England Journal of Medicine” published a report. New England Journal of Medicine, the most authoritative international clinical medical journal, published a new study that nearly half of the people in the U.S. who should not have had a heart stent put in were put in a stent. This is the latest data on overmedication in the world. In this regard, Prof. Hu Daiyi, Chairman of the Chinese Medical Association’s Cardiovascular Disease Branch and President of the Chinese Physicians Association’s Cardiovascular Physicians Branch, said, “China’s misuse of cardiac stents is not more optimistic than that of the United States. Abroad, few patients need more than 3 stents, but domestically, many patients were put 5-10 stents, which is obvious overmedication.” In 2009, a total of 230,000 cases of cardiac interventions were performed in China, and if calculated on the basis of two stents per capita, the cost of consumables alone was at least 5 billion yuan. How many of these stents were ineffective and unhelpful? The misuse of new medical technologies has become a common global phenomenon. Patients not only bear unnecessary pain and risks, but also pay expensive medical bills. Stent supporting drugs have side effects Although cardiac stents are disposable, putting in a stent that shouldn’t be put in is lifelong, and the mental stress, drug side effects, and inconvenience of performing other surgeries it brings to the patient won’t disappear with time. Almost all of the cardiac stents currently used in China are medicated stents, which are not only more expensive compared to bare stents, but also require a year’s worth of clopidogrel and lifelong aspirin to fight blood clots, which can irritate the gastrointestinal tract and pose a bleeding risk. There are also some patients who feel localized discomfort in the heart after the stent is put in, and it takes a year for them to get used to it. Experts have encountered some “back to the stove” patients, some of whom do not meet the indications for interventional therapy, but were put into one or even more stents, due to the failure to take medication on time after the operation, blood clots, leading to more serious myocardial infarction. Why the abuse of cardiac stents? Some hospitals treat it as an economic growth point and a cash cow, and doctors also attach great importance to the benefits brought by stents. A small stent, with a diameter of 2-4 millimeters and a weight of less than one ten-thousandth of a gram, costs 10,000-20,000 yuan domestically produced, and the price of imported stents is doubled, so the interests behind them can be seen. Another reason is that doctors are overly obsessed with technology. Experts: “medicine from the humanities and the service object gradually farther and farther away, doctors quickly into a specific field of operation, ignoring the comprehensive analysis of the patient’s condition. On the surface of the injury is the patient, in fact, the biggest victim is the doctor, and will eventually lose the trust of patients, society on them.” Put stent is not once and for all Singapore health insurance department, the need to put stent patients, each person can only be reimbursed a maximum of three, if more than, a medical insurance department does not give reimbursement, and the second doctor has to make a statement of justification to the special committee. Experts believe that China also needs to develop similar standards to regulate the placement of stents. “Over-placement of stents is not only due to doctors, but also from the patient’s side.” The relevant professor introduced, many patients think that taking medicine and injections is too troublesome, and placing a stent can be done once and for all, and can go to the root, often requesting to place a stent by themselves, and quarrelling with the doctor if he or she disagrees. Many people continue to smoke after the operation and do not take medication on time, resulting in a quick relapse of the disease or the emergence of new lesions. “A phenomenon that goes hand in hand with the overuse of stents is that patients who should be put on stents are not treated in time.” The relevant professor introduced. For example, acute heart attack patients, is the most should be emergency stent surgery, but many patients and their families do not have this awareness, the hospital also did not effectively ensure that the green channel for heart attack rescue is open all year round, resulting in the condition is delayed, missed the timing of the operation. Bypass and stenting should go hand in hand Experts pointed out that, in fact, many patients with coronary heart disease can change their lifestyles and behavioral hobbies to alleviate the condition, the effect is very significant, such as no accidents, there is no need to place a stent in the heart. For example: his teacher is a famous cardiologist, 70 years old when angina pectoris, he did not go to do coronary, put a stent, but on the basis of maintaining a healthy lifestyle, adhere to oral statin and coronary heart disease medication, is now 87 years old, can still easily go up to the second floor. Even if surgery is needed, heart bypass surgery has been around for more than half a century and is a very mature technology, but it is not chosen by some doctors because of its trauma, complexity and low success rate. “Some doctors tell patients that coronary artery disease can be bypassed or intervened, and that bypassing requires opening the chest and intervening does not, and I think this kind of guidance is very ridiculous.” Hu Daiyi said that internationally, the ratio of stent and bypass surgery is 7:1 to 8:1, but in China, the ratio is as high as 12:1. The expert pointed out that, in putting heart stents, and even appeared between hospitals “simply compare the number of surgeries,” the phenomenon of “a hospital can not pass the three hospitals A hospital’s ability to pass the third-class hospital accreditation, how many cases of interventional surgery is a landmark indicator, like the GDP.” The same heart disease, why different life? In addition to individual differences, the ability to choose the appropriate treatment program is an important influence. It should be recognized that the birth of cardiac interventional technology is a major advancement in medicine, which replaces part of the heart bypass surgery and reduces the trauma and pain of patients. However, any medical technology has boundaries. Once the boundaries are exceeded, it goes in the opposite direction. Experts point out that placing a stent on a patient without indications will greatly increase the risk of blood clots or bleeding, leading to more serious myocardial infarction. Zongwo Link After stenting, stenosis may still occur A few heart disease patients have the misconception that once they have undergone cardiac stenting, their heart is equivalent to double insurance. Some people even insist on using imported stents in the operation, thinking that there is quality assurance. In fact, it doesn’t matter whether the heart surgery stent is imported or not. Experts say that no matter how many times the quality of the stent has been improved, it can never solve the ultimate problem, because cardiac stenting is not a treatment for the cause of the disease, and although it solves the cardiovascular unclogging, it does not guarantee that the other network of blood vessels will be unobstructed. In a sense, therefore, convalescence after cardiac stenting, and secondary prevention of atherosclerosis throughout the coronary arteries, are the challenges that heart patients really begin to face. A recent clinical practice showed a high incidence of thrombosis after stent placement, even on the basis of adequate antiplatelet therapy. Why is this the case? Because placing a stent causes slight damage to the endothelium of the vessel. The damaged endothelium will slowly repair itself along the stent, but this requires a process. During this process, platelets build up in the damaged area and thrombi form again. As we all know, the consequences of blood clots are often very serious, causing reocclusion or even acute myocardial infarction.