[Local Medical]Determine treatment plan based on the condition

Written by ◆Chen Qiulei and compiled by ◆Liang Yingxiu

High cholesterol, fat accumulation, calcification and smoking are the main causes of coronary artery disease. There are three treatment methods, namely taking medicine, taking medicine and performing angioplasty or heart bypass surgery.

Doctors will consider several factors to develop a plan suitable for the patient, including the number of coronary artery obstruction points, age, physical condition and personal wishes, etc., in order to achieve the ideal treatment effect.

(Kuala Lumpur News) The heart is an important organ that pumps blood supply, that is, it can pump oxygenated blood to the whole body and pump deoxygenated blood to the lungs to supplement oxygen. There are many heart-related diseases. Among various heart diseases, coronary artery disease, or coronary heart disease, is a cardiovascular disease that everyone is familiar with.

The blood supply mentioned above is transported through the cardiovascular system, but some people have internal lesions in their blood vessels, causing blood flow to be blocked, which in turn causes the coronary artery disease mentioned above.

Medication can be taken if blood vessels are slightly narrowed

Dr. John Chan Kok Meng, consultant cardiothoracic and pulmonary surgery, pointed out that vascular disease occurs due to high cholesterol, fat accumulation and calcification, which narrows the originally normal blood vessels. If the degree of narrowing is only mild, most patients can control the risk factors that cause the narrowing, such as cholesterol, blood sugar, and blood pressure, after taking prescribed medications.

Patients can take medicines that relax the heart’s pulse, allowing blood to flow more smoothly through the heart; or they can take medicines that thin the blood, which reduces the chance of blood clotting in the narrowed area.

Fortunately, most patients can successfully control their disease through treatment with the above drugs. Because as long as the condition is not serious, it can be controlled with medication and by paying attention to daily life, it can prevent it from getting worse.

“However, if the medicine is still ineffective after taking it,

For example, if the patient feels chest pain or shortness of breath or difficulty breathing,

Then, another treatment plan must be adopted at this time,

Angioplasty, also known as percutaneous coronary intervention

(Percutaneous Coronary Intervention, PCI),

Or Coronary Artery Bypass Surgery (CABG). “

PCI is commonly known as “Tongbozi”. The surgeon usually injects local anesthesia into an artery in the arm or foot and then places a small catheter into the artery. Under the guidance of X-ray, the catheter is pushed to the heart, directly to the aorta, left coronary artery, and right coronary artery, and the blockage is found by injecting contrast agent, and the catheter is pushed to the blockage again.

Once the point of coronary artery blockage is confirmed, the doctor implants the stent. The stent wrapped in a plastic sheath (balloon) is compressed to a very small size. When we pull the sheath back, the stent will expand, which can open the narrowed artery. arteries.

New-generation stents have longer-lasting drug properties

Generally speaking, patients with severe calcification or multiple coronary artery disease are most suitable for CABG. This surgery can not only extend the life of these patients, but also allow them to enjoy the best quality of life. However, some patients are at higher risk because they are older or suffer from multiple diseases, so doctors must first perform rotational atherectomy (RA), which involves drilling and opening up the calcium plaque covering the blood vessel wall. Then perform PCI.

It is worth mentioning that the currently used drug coated stent has been upgraded to a new generation, and its drug properties are more durable and effective.

As for CABG, he said, the process is much more complicated than PCI. When performing CABG, we remove blood vessels from other parts of the human body, such as the chest wall, arms, or legs. After connecting the removed blood vessels to the original blood vessels, we sew the other end to the heart, thus bypassing the blockage. Since the entire danger zone has been bypassed, new lesions may develop in the future because the blood can still reach the end point.

Since they are all cardiovascular diseases, can the effect be achieved by using one of the above two methods for treatment? Chen Guoming admitted frankly that this may not actually work.

Doctors use their professional judgment to adopt corresponding medical interventions and plans based on various factors, such as disease, severity, age, physical condition and personal wishes, so as to achieve the ideal treatment effect.

“For example, a patient’s condition is not serious and he feels chest pain when walking. This is what we call stable coronary heart disease. We can know the severity of the coronary artery disease from further examinations to determine the patient’s treatment. regimen, i.e., medication, PCI, or CABG.”

“Some patients feel unwell and have great pain in their heart, which happens when a blood vessel suddenly becomes completely blocked. We call this a heart attack, and PCI is the ideal solution to treat these conditions.

PCI if symptoms persist after taking medication

He further explained that in most patients whose cardiovascular blockage is not serious, the prognosis of taking medication is very ideal, but if symptoms still persist after taking medication, PCI is recommended.

For those whose blockage occurs in multiple blood vessels, and some patients even have multiple blockages in one blood vessel, it is feasible to perform CABG because it allows the patient to live longer and avoid symptoms. However, it is only for the elderly or People with other medical conditions are at higher risk. In fact, it is not necessarily impossible to use PCI, but it may cause problems in the future and require more medical intervention.

The main reason is that new diseases may develop before or after the implanted stent, and doctors do not rule out the possibility of lesions inside the stent. When the patient feels discomfort again and surgery becomes necessary, another stent must be inserted.

From such cases, doctors have found that for patients with more severe conditions, if multiple stents are implanted in each blocked cardiovascular system, this will not bring about long-term ideal effects, and their symptoms will not be improved.

“If a patient has multiple cardiovascular obstructions, or multi-vessel disease, based on the long-term results and future risks, we generally will not recommend PCI, but rather It is better to choose CABG.”

CABG is recommended for those under 70 years old

The human body’s cardiovascular system is like a highway that originally led to a small town. The first part of the road was blocked, but doctors later built a new ‘highway’ that allows blood to go directly to the heart. The advantage of CABG treatment is that it creates a new blood supply channel, so that blood can still flow unobstructed, and its curative effect is longer-lasting.

To be precise, doctors decide which treatment method is suitable for the patient based on two aspects: the number of blood vessel blockage points and the location of the blockage. PCI is more suitable for patients with one or two blood vessel blockages; for patients with multiple blood vessel blockages, CABG is more appropriate if the blockage is located at the entrance of the left coronary artery.

Still, he said treatment options would be adjusted based on different circumstances. In the long run, the effect of CABG treatment is better, but if we take an elderly person over 80 years old or a patient with multiple diseases as an example, the risk of CABG is too high for them, then PCI is the best option.

However, he recommends CABG for patients under the age of 70 who are in good health, or for those who are in good health and have polyvascular disease.

“As a doctor, of course I try my best to treat my patients, but sometimes it depends on the patient’s own wishes. Therefore, personalized treatment will be carried out according to each patient’s expectations.”

Postoperative recovery periods vary

CABG survival rate is higher than PCI

According to a research report titled “The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX)” trial published in the British medical journal “The Lancet” in 2019, Compared with PCI, CABG has a lower 10-year mortality rate.

PCI is a minimally invasive surgery and the patient was discharged within two days

Another study published in the Lancet medical journal in 2018 on the 5-year mortality rate of diabetic patients undergoing CABG also pointed out that compared with PCI, CABG can help reduce mortality; diabetic patients with For patients with low cardiac function, CABG treatment has a higher survival rate than PCI in the long run.

PCI and CABG have different recovery periods after surgery. Because the former is a minimally invasive surgery, you only need to stay in the hospital for one to two days before being discharged. You can return home to recuperate for a few days before returning to life; CABG is For open surgery, the patient usually has to stay in the hospital for at least a week and recover for about a month before returning to normal. During this period, do not move or pull heavy objects; it will take 3 months to fully recover.

Both treatment options have their own advantages and disadvantages, but it is worth mentioning that the risk probability before, during and after surgery is 1%, but the occurrence of these medical accidents is very rare.

Although the medical effects of the two surgeries are considerable, Chen Guoming would like to advise everyone to still take care of their bodies and adjust their living and eating habits, such as controlling the intake of alcoholic beverages, quitting smoking, and doing exercise. In addition, follow the doctor’s instructions carefully, take medicine on time, and control the three highs, so as to reduce the chance of recurrence.

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