Coronary heart disease is one of the common chronic diseases among middle-aged and elderly people, and it is also the second leading cause of death among Chinese residents.
At present, coronary stent implantation technology is quite mature and cannot be improved through lifestyle alone. Patients whose disease is controlled with drug therapy may receive coronary intervention for effective treatment.
However, many people believe that once a stent is implanted, they can "sit back and relax". On the contrary, in order to prevent postoperative recurrence, stent thrombosis, restenosis and other complications, and to prevent the continued development of coronary heart disease in the future, the following precautions must be paid attention to!
To avoid re-stenosis of coronary vessels or rapid progression of atherosclerosis, risk factors must be well controlled.
The main risk factors for coronary heart disease are gender (male), smoking, drinking, poor living habits (diet), obesity/overweight, hypertension, dyslipidemia, diabetes, other genetic factors, and psychosocial factors. Among them, gender and genetic factors are unchangeable factors, and the rest are controllable factors.
Therefore, in addition to a low-salt and low-fat diet, smoking cessation and alcohol restriction, appropriate exercise, weight loss, etc. to improve their lifestyles, patients with hypertension, diabetes and hyperlipidemia also need rational medication to control blood sugar, blood pressure and blood lipids at appropriate levels. Patients without three highs should also pay attention to the levels of blood sugar, blood lipids, and blood pressure.
Coronary stents only temporarily open the "culprit vessel", that is, the most severe stenosis, while the stenosis of other parts still exists. In addition to preventing the rapid development of arteriosclerosis, drug treatment can also prevent complications such as stent thrombosis and restenosis. happened. Therefore, patients after coronary artery stent procedure are more high-risk groups and need to be prevented.
1. Antiplatelet drugs
Aspirin + clopidogrel, dual antiplatelet therapy, is a key treatment to reduce the risk of in-stent restenosis and thrombosis.
If there are no contraindications, routine "dual-antibody therapy" (clopidogrel 75 mg qd/ticagrelor 90 mg bid + aspirin 100 mg qd) should be routinely followed after PCI, and aspirin is maintained for a long time.
For patients undergoing interventional therapy without coronary stent placement, postoperative clopidogrel 75 mg/d dual antiplatelet therapy should be continued for at least 28 days, preferably 12 months.
For patients undergoing stent implantation (whether bare-metal or drug-eluting stents), dual antiplatelet therapy for at least 12 months postoperatively.
2. Lipid-lowering drugs
Commonly used drugs are statins lipid-lowering drugs, which are the cornerstone of dyslipidemia drug treatment. In addition to lowering blood lipids, they also inhibit inflammation, improve endothelial cell function, stabilize or reverse atherosclerotic plaques, and inhibit liver synthesis of excessive cholesterol, etc. effect.
If there are no contraindications, all patients with coronary stent implantation should use β-blockers, whose specific effects are to slow down the heart rhythm, reduce the myocardial contractility rate, thereby reduce myocardial oxygen consumption, improve myocardial ischemia, and improve the patient's longevity. period prognosis.
β-blockers can be selected from metoprolol, bisoprolol and carvedilol, and the dose can be adjusted individually. It is better to control the resting heart rate of the patient at 55-60 beats/min.
4. Angiotensin-converting enzyme inhibitor (ACEI)
These drugs can improve vascular endothelium, promote vasodilation, reduce cardiac load, improve myocardial function, resist myocardial ischemia, and resist ventricular remodeling. Improve the long-term prognosis of patients.
If there are no contraindications, all patients with coronary heart disease should use ACEI. If the patient cannot tolerate ACEI, ARB drugs can be used instead.
Such as nitrates, calcium ion antagonists, drugs to improve myocardial energy metabolism, etc., and some traditional Chinese medicines can improve coronary microcirculation, protect vascular endothelium, and promote angiogenesis.