Coronary artery disease (CAD) is one of the most preventable of all diseases yet it affects almost 13 million Americans, making it the most common form of heart disease. In the US about 1.5 million heart attacks occur annually. Complications of CAD are leading causes of death for both men and women in the United States. Treatments are aimed at controlling symptoms and slowing or stopping the progression of CAD. For patients, it is imperative to know what types of treatment options are available.
Risk factors for CAD include, but are not limited to: hypertension, elevated blood sugar, and high cholesterol levels leading to hardening of the artery. These causes can lead to a buildup of material that forms inside the arteries of the cardiovascular system. In the case of CAD this build up, known commonly as plaque, is in the arteries of the heart. Coronary artery plaques generally consist of cholesterol, fatty compounds, calcium and in some cases immune response cells. As plaque builds in the artery, the pathway of blood narrows, whereby limiting blood flow.
For those patients in the midst of a heart attack, percutaneous coronary intervention (PCI) has been shown to be superior to any other treatment option for quick assessment and treatment of the affected coronary artery. Patients that are transported to facilities that offer the ability to perform a PCI within a short time have a dramatic advantage over those patients who do not have this immediate option. Research has shown that in the instance of a heart attack the best PCI results occur when the procedure is conducted within 90 minutes of the time of arrival to the treatment facility. This is due to the fact that during a heart attack, the heart muscle or myocardium is starving for oxygen rich blood and total occlusion or blockage of a coronary artery for durations of more than 4-6 hours results in irreversible heart damage. Opening the blockage within this small window of time can salvage the affected area of the heart and improve a patient's chance of survival.
In some instances during a PCI extra measures must be taken to maintain an open artery. A small hollow metal spring-like device called a stent is placed at the blockage location. Stents can be deployed over the angioplasty balloons and are then left within the coronary arteries of the heart to help keep them free of plaque blockage. Stents help prevent abrupt closure of arteries shortly after angioplasty. Stents also prevent recurrent narrowing of the coronary artery and decrease the risks of the arterial vessel tearing or rupture, elastic recoil, and arterial spasm, all of which can occur after PCI procedures. The widespread use of coronary stents has reduced the incidence of repeat occlusion of the artery by as much as 50%. There also has been a recent introduction of coated stents also know as drug eluting stents, which are coated with chemicals to further reduce the chance of developing another blood clot in the same location. These newer drug eluding stents have been shown to reduce the incidence of coronary artery re-occlusion to well under 10% and have been a major improvement in treatment.
Research in the field of cardiovascular medicine is constant and treatment standards with research continue to change and improve. Since each case is unique only physicians and patients together can decide which treatment option is the best for that individual.
Heidi Starr, RN, BSN, is a registered nurse in the cardiac catheterization lab at Mount Nittany Medical Center.