After heart stenting, do four perseverances to make you live healthier

Since the first time a stent was implanted into the heart by scholars from Sweden in 1987, three generations of stents have been developed so far. First generation: bare metal stent (BMS) ; second generation: drug-eluting stent (DES) ; third generation: absorbable biodegradable stent . The mainstream stent currently in use is the second-generation drug-eluting stent. The first-generation has basically been eliminated, and the third-generation is still being improved.

Heart stent has saved thousands of lives with coronary heart disease every year since its inception. Especially for patients with coronary heart disease who suffer from acute myocardial infarction , the heart stent is the first choice for reopening the blocked blood vessel. For patients with coronary heart disease without myocardial infarction, heart stents can also greatly improve the quality of life of patients.

The advantages of heart stents seem to be many. So for patients with coronary heart disease, after installing the stent, can you sit back and relax? Obviously not, the bracket is not that magical yet. Today, I’m going to share science with you, what should patients with coronary heart disease do after the stent is installed, and do four perseverances to make you live healthier.

First, insist that the medicine cannot be stopped, and the antiplatelet should be strengthened.

Some patients may ask if I can take less medicine after installing the stent. Some unimportant medicines can be omitted. For example, some patients with coronary heart disease will have angina before the stent is installed, so they should take medicines such as Shexiang Baoxin Pills; then, after the stent is installed, if chest tightness and angina are not You can skip it. However, none of the important drugs can be stopped, and the antiplatelet drug has one more than before. After the stent is installed, it must be double-resistant for at least 12 months. Double antibodies can reduce the risk of myocardial infarction by 27%.

1. Anti-platelet should be strengthened

Before installing the stent, take an antiplatelet drug- aspirin, called a monoclonal antibody; after installing the stent, take two antiplatelet drugs, called a double antibody .

1. Why is the stent installed and the anti-platelet strengthened

• As mentioned above, the mainstream stent currently in use is the second-generation drug-eluting stent (DES), which is coated on the surface of the stent The drug will slowly release the drug after being put into the blood vessel. This drug can prevent the excessive proliferation of the vascular endothelium and the restenosis in the stent.
• The first generation of bare metal stents, the incidence of in-stent restenosis is about 15%-20%, which is unacceptable. The second-generation stent solves this problem well, reducing the rate of restenosis in the stent to about 3%-5%. The second-generation stent is mainly to solve the problem of restenosis in the stent.
• But the second-generation stent was not perfect. After solving the problem of restenosis in the stent, another problem appeared, that is, the formation of thrombus in the stent. Because the drug in the stent prevents the proliferation of the vascular endothelium, the stent is not covered by the endothelium, and the stent is exposed in the human blood vessels. As a result, it is easy to grow thrombus and block the blood vessels. Therefore, after the stent is installed, the anti-platelet needs to be strengthened, and two anti-platelet aggregation drugs are needed to prevent the occurrence of thrombosis in the stent

2. Which two antiplatelet drugs are respectively

• One of the double antibodies is aspirin, which is the cornerstone of coronary heart disease treatment , the most used antiplatelet drug in the world. The other one, it can be clopidogrel ( polyvi ),It can also be ticagrelor (Belinda).
• Difference between the two: Compared with clopidogrel, ticagrelor inhibits platelet faster and has a stronger effect. However, ticagrelor also has shortcomings. The incidence of dyspnea after taking it is relatively high, reaching 14.5%. Among patients who stopped taking ticagrelor, 55.6% were due to dyspnea.
• After taking clopidogrel, it has to be transformed by the human body before it can take effect, so the effect is slightly slower. Moreover, clopidogrel requires the body's CYP2C19 gene to function, and some people do not have this gene, and the effect of taking clopidogrel is very poor.
• It is recommended to choose ticagrelor for the following conditions: diabetic patients, chronic kidney disease patients, acute coronary syndromes (including acute myocardial infarction and unstable angina) combined with complex coronary artery disease ( Including two-vessel bifurcation disease, multi-vessel disease, post-bypass disease, etc.)

2. Statin treatment should continue

Statins are another treatment for coronary heart disease Cornerstone, the word cornerstone shows its importance. Therefore, patients with stents should continue to eat.

• The effect of statins : Statins can not only lower blood lipids, but also stabilize plaques, delay plaque growth, and even reverse plaques. Statins mainly reduce low-density lipoprotein ( LDL ) in blood lipids. For every 1mmol/L decrease in LDL, the risk of major cardiovascular events (including myocardial infarction, severe arrhythmia, heart failure, etc.) decreases by 20%.All-cause mortality decreased by 10%.
• Adverse reactions of statin drugs : It is a drug that is three-point toxic. The ancestors know this truth, and it is still the same today. Although statins are good medicines, there are disadvantages. Statins may affect the liver and muscles. When you first take a statin, it is recommended to check ALT , AST and CK for about 1-2 months. These indicators can reflect whether there is any problem with the liver and muscles. If there is no problem, It can be reviewed every 6-12 months.
• Of course, there is no need to worry too much about the adverse reactions of statins, because most of the statins used by Chinese people are medium-dose statins, that is, atorvastatin 20mg and rosuvastatin 10mg. Medium-dose statins are still very safe.

3. Coronary heart disease The best combination of drugs is best to use

There is a best combination of drugs for coronary heart disease treatment, namely: + + statin ACEI /ARB+ β-blocker , the best combination is that these drugs have an effect on reducing the mortality of coronary heart disease and improving the prognosis. The effects of aspirin and statins have been discussed before and will not be repeated.

1, ACEI/ARB drugs

• ACEI/ARB drugs are a class of antihypertensive drugs , and the name behind it is XX Pri/XXsartan .Therefore, for patients with coronary heart disease and hypertension, the first choice for antihypertensive drugs is ACEI; If ACEI drugs cannot be used for , then choose ARB.

• In addition, in addition to lowering blood pressure, it also can delay the ventricular remodeling caused by chronic ischemia of coronary heart disease, and can also reduce the mortality of coronary heart disease. Therefore, in patients with coronary heart disease and heart failure, or left ventricular ejection after myocardial infarction, score LVEF<40%> should take ACEI as soon as possible. If ACEI drugs cannot be used, , Then choose the ARB category.

• After coronary heart disease is installed with a stent, it is not once and for all. The risk factors that should be avoided should still be avoided. Stents are only a cure for the symptoms but not the root cause, and have no effect on the final mortality rate of coronary heart disease.
• The risk factors for coronary heart disease continue to exist. Plaques will grow outside the stent, or even inside the stent. Therefore, for patients with coronary heart disease, risk factors should always be avoided. For example, there are three highs, and drugs for lowering blood pressure, lipids, and blood sugar must continue to be taken.
• Some risk factors for coronary heart disease are and inevitable , for example, the incidence of coronary heart disease increases when the age is older, and the incidence of men is higher than that of women. Parents with coronary heart disease have a higher probability of coronary heart disease in their children.
• There are other risk factors that can be artificially intervened. Such as "three highs", smoking, obesity or overweight.
• For obese patients, lose 5%-12% of body weight within 6-12 months, waist circumference ≤90cm for men and ≤85cm for women.
• For hypertensive patients, the basic blood pressure control target is 140/90mmHg, for patients with diabetes, the standard is lower, controlled at 130/80mmHg. For the elderly, some requirements can be relaxed and the systolic blood pressure can be controlled within 150mmHg, if it can be lower, it is best.
• For diabetic patients, control the glycosylated hemoglobin within 7%.
• The target value of blood lipids : Patients with coronary heart disease, blood lipids mainly focus on low-density lipoprotein (LDL). previously believed that patients with coronary heart disease should at least reduce their LDL to less than 1.8.The new European guidelines in 2019 further reduce the LDL standard. It is now believed that patients with coronary heart disease should be able to reduce it below 1.4 mmol/L (55mg/dl), and the reduction rate is > 50%.

3. Adhere to a healthy lifestyle

For patients with coronary heart disease, adhering to a healthy lifestyle is equally important and cannot be ignored. Poor lifestyle control is unfavorable for the intervention of risk factors for coronary heart disease, such as the control of blood pressure and blood sugar.

1. Smoking cessation and alcohol restriction

1. Smoking cessation

• Smoking itself not only promotes the formation of atherosclerosis, but the key is that smoking can cause plaque instability and cause acute myocardial infarction. Acute myocardial infarction is the most common cause of coronary heart disease. One type of danger, the most feared by patients with coronary heart disease is the occurrence of acute myocardial infarction.
• Studies have shown that the average age of onset of acute myocardial infarction in smoking patients is 10 years younger, and the risk of onset is 6 times that of non-smokers. In patients with coronary heart disease, after quitting smoking, the risk of myocardial infarction can soon be reduced to a level similar to that of non-smokers.
• Patients after coronary heart disease stent surgery, in addition to active smoking, second-hand smoke should also be actively avoided.

2. Limit alcohol

• Excessive drinking can significantly increase the risk of hypertension, and the risk increases with the increase in alcohol consumption.
• For patients with hypertension, the recommended daily alcohol intake should be less than 25 grams for men and 15 grams for women. The weekly alcohol intake is less than 140 grams for men and 80 grams for women.

Limit alcohol consumption

2. Reasonable diet

1. Reduce sodium intake,Increase the intake of potassium salt

• Sodium salt is mainly found in the salt we eat, and other things including monosodium glutamate and soy sauce are also contained. Eating too much salt can significantly increase blood pressure, especially for us Chinese, most of whom are salt-sensitive physiques. Too much salt intake is also an important cause of high blood pressure in our residents.
• Therefore, usually reduce the intake of sodium salt and keep the daily salt consumption within 6 grams. Usually use a fixed amount of salt spoon for cooking, and eat less high-salt foods such as pickled vegetables, ham, and preserved products.

2. Low-fat and low-sugar diet

• Patients with coronary heart disease should reduce the intake of saturated fatty acids, trans fatty acids and cholesterol, such as butter, fried foods, and fatty meat.
• In addition, for patients with diabetes, they should have a low-sugar diet, eat less and more meals, and usually eat fruits, vegetables, low-fat dairy products, grains, and plant protein.

III. Regular work and rest

• Work and rest should be regular, don’t stay up late. Try to rest at the same time every day and develop good habits. Patients with insomnia can take sleeping pills appropriately.

4. insist on moderate-intensity exercise

Some people may not dare to exercise after installing the stent, because they are afraid of the stent moving. This is not to worry, the stent is still very strong in the blood vessel. With the bracket installed, proper exercise is still required.

• For patients with coronary heart disease after installing a stent, moderate-intensity aerobic exercise is still recommended. Exercise 4-7 days a week and 30-60 minutes of moderate-intensity exercise every day. The form of exercise is not limited, it can be walking, jogging, biking, etc.
• About moderate-intensity exercise: the heart rate reaches 60%-70% of the maximum heart rate during exercise,[Maximum Heart Rate=220-Age]
• It is important to note that with regard to exercise, it is also necessary to do what you can, do not force it. Don't exercise to complete the task, and feel comfortable after exercise, not uncomfortable.

5. The patient's inner regulation

• After coronary heart disease patients are installed with a stent, some people will have psychological problems, such as depression and anxiety. Studies have found that depression and anxiety are related to all-cause mortality in the 10-year postoperative period.
• Therefore, the patient's family should promptly enlighten to help the patient overcome bad emotions. In addition, the patient himself must face it bravely.

Fourth, adhere to the postoperative follow-up

After the heart is put on the stent, just ignore it, of course it won’t work. Buying a home appliance has after-sales service, not to mention something related to life. The purpose of the postoperative follow-up is mainly for the doctor to look at the patient: how is the medicine used, assess the heart function, and the stent condition, whether there is re-stenosis.

1. What to review

• Blood test: liver function (ALT, AST), blood lipids, CK, blood glucose
• ECG, cardiac color Doppler ultrasound
• coronary CT or coronary angiography (not every one Everyone has to review)

2. When to review

1) Liver function (ALT, AST), blood lipids, CK

Because the statin is taken before the stent is installed, so these can be 6 Check once a month.

2) ECG

can be checked every three months

3) Echocardiogram

checked every 6 months

I think these are not very absolute, you must check when the time is up. For example, with echocardiography, if coronary heart disease is very mild and only one blood vessel is blocked, the heart function is very good, and it can be checked once a year. (For details, please refer to the figure below, subject to the respective attending doctor)

3. What conditions need to be reviewed for angiography

• Symptoms of angina, chest tightness and angina or chest tightness 44_lili45 Diabetes
• Many branches of blood vessels have problems, but only the most serious one has been solved, and other blood vessels have more than 50% stenosis.
• The procedure is very complicated
• Patients with stenosis of the left main stem
• Patients with stents rescued by cardiopulmonary resuscitation due to sudden death

After the postoperative review, we must continue to avoid risk factors and adhere to a healthy lifestyle. Only in this way can we live healthier lives.

I am Dr. Chen who insists on popularizing medical science. If you think what I wrote is okay, remember to like and follow. Your support is the biggest motivation for my creation.