Investigation Of The Pattern Of Evolution For Different TCM Syndrome Type Elements Post-PCI

Coronary heart disease (CHD) is one of the most commonly occurring illnesses today, as well as one of the leading cause of death in the world. Coronary revascularization, in particular, percutaneous coronary intervention (PCI), is an important advancement in the treatment of CHD. Employing TCM therapy and PCI treatment simultaneously is a topic for debate and a relatively new area. There have been previous research involving Syndrome Types post-PCI in the recovery stage, but little research has been done so far for the acute stage. As TCM can play a significant part in this stage as well, and investigations on the different Syndrome Types is fundamental to further TCM treatments, the significance of this study should not be overlooked.Objective:To have a better understanding of the evolving TCM Syndrome Types post-PCI for patients in its acute stage, as there is currently insufficient research for this particular area, and to derive certain patterns from the data collected which may be significant to further TCM treatments.Methodology:A prevalence survey was designed to investigate TCM Syndrome types and related physiochemical data. Detailed data of 332 patients admitted to the Emergency Ward in Anzhen Hospital from October 2013 to March 2014 with PCI performed was collected and recorded in a standardized manner. The Syndrome Type elements of each patient before the procedure and 8 hours, 24 hours,48 hours post-PCI respectively was carefully recorded. The distribution of the Syndrome Types were analysed in terms of their frequency and composite percentage. Changes in the Primary and Secondary Syndrome Types were investigated using survival analysis to determine the time pattern for their evolution and disappearance. Correlation analysis was used to investigate the relationship between TCM Syndrome Types and the diseases involved.Results:1. Qi Deficiency is the basic pathogenesis for CHD. The rate of detection for Qi Deficiency in the perioperative period was the highest, at 95.18%, 97.89%,96.39% and 93.07% respectively; the rate of detection for Qi Deficiency as the Primary Syndrome Type was also the highest, at 44.58%, 42.47%,48.80% and 46.40% respectively, and there were basically no significant changes throughout. This is relatively consistent with findings reported in other research and articles.2. Blood Stasis was relieved after PCI and the detection rate was 50.60%, 43.98%,28.61% and 29.52% respectively. This was particularly evident for 24hrs post-PCI. The rate of detection for Blood Stasis as the Primary Syndrome Type was 27.71%、21.08%(8 hrs post-PCI versus pre-operative, P=0.0468)、9.64%(24 hrs post-PCI versus 8 hrs post-PCI, P=0.0001) and 9.00%(48 hrs post-PCI versus 24 hrs post-PCI, P=0.7897) respectively. This suggests PCI and related anti-coagulation treatments may effectively relieve blood stasis.3.Yin Deficiency and Stagnant Heat was elevated post-PCI. The rate of detection for Yin Deficiency was 42.17%, 52.71%, 53.01% and 55.72% respectively, and elevated significantly 48 hours post-PCI. The rate of detection for Yin Deficiency as the Primary Syndrome Type was8.43%、20.78% (8 hrs post-PCI versus pre-operative, P=0.0001)、19.88%(24 hrs post-PCI versus 8 hrs post-PCI, P=0.7724)、21.10%(48 hrs post-PCI versus 24 hrs post-PCI, P=0.7005). The rate of detection for Stagnant Heat was 35.54%, 22.29%, 39.76% and 53.92% respectively, and elevated significantly 48 hours post-PCI. The rate of detection for Stagnant Heat as the Primary Syndrome Type was 9.64%, 6.02%(8 hrs post-PCI versus pre-operative, P=0.0830)、12.05%(24 hrs post-PCI versus 8 hrs post-PCI, P=0.0830)、 12.05% (48 hrs post-PCI versus 24 hrs post-PCI, P=0.0830). This might be due to the fact that PCI is theoretically similar to TCM Traumatic Reactions which usually exhibits as Heat caused by Yin Deficiency.4. When comparing the changes of primary Syndrome Types pre and post-PCI, the number of cases of Stagnant Qi and Yin Deficiency pre-PCI to 8 hours post-PCI increased whereas the others decreased. The difference between their distributions is statistically significant (p<0.0001). The distribution of Syndrome Types was also different pre-PCI and 8 hours post-PCI with Qi Deficiency and Blood Stasis as the main Syndrome Types, out of which Blood Stasis (P=0.0468) and Yin Deficiency (P=0.0001) was significantly different statically. The number of cases of Stagnant Qi, Stagnant Heat and Qi Deficiency 8 hours to 24 hours post-PCI increased, the number of cases of Stagnant heat in particular doubled, the occurrence of Coagulated Cold remained the same, while the others decreased. The difference between their distributions is statistically significant (p<0.0001). The distribution of Syndrome Types was also different 8 to 24 hours post-PCI, out of which Blood Stasis (P=0.0001) and Stagnant Heat (P=0.0068) was significantly different. The number of cases of Stagnant Heat and Yin Deficiency 24 to 48 hours post-PCI increased, whereas the that of Qi Deficiency and Blood Stasis decreased. The difference between their distributions is statistically insignificant (p >0.05). The difference between the distributions of Syndrome Types 24 to 48 hours post-PCI was also statically insignificantly.5. From the changes of Primary and Secondary Syndrome Types shown above: 87 cases of Qi Deficiency as the secondary Syndrome Type was converted to it being the primary Syndrome Type, this is significantly higher than it being converted from the primary to the secondary Syndrome Type.56 and 26 cases of Yin Deficiency as the primary Syndrome Type was converted to it being the Secondary Syndrome Type 8-24 hours and 24-48 hours post-PCI respectively. Blood Stasis was converted from the primary to the secondary Syndrome Type throughout, with 25,4, and 3 cases respectively.6. According to survival analysis and the pattern of evolution for the main Syndrome Type Elements, it was discovered that Qi Deficiency was relieved 18.60 hours post-PCI, Blood Stasis was relieved 23.75 hours post-PCI, both taking a relatively longer period of time for significant relief, suggesting that Promoting Qi should be the focus in terms of treatment post-PCI, and Promoting Blood flow to relieve Blood Stasis should not be employed prematurely. Adjustment to treatments should be made according to the pattern of evolution for the different Syndrome Types to yield the best results. Stagnant Heat was elevated in an average of 8.89 hours post-PCI, Yin Deficiency was elevated in an average of 5.14 hours post-PCI, suggesting that Stagnant Heat and Yin Deficiency appears early on post-PCI, therefore TCM treatments immediately post-PCI should pay attention to Nourishing Yin and prevention of Stagnant Heat.Conclusion:1.CHD has a fundamental pathogenesis of Deficiency but often manifests as Asthenia Syndromes. Common forms of Deficiency includes Qi, Yin and Yang Deficiency with Qi Deficiency as the leading Syndrome Type; common forms of Asthenia Syndromes includes Blood Stasis and Stagnant Heat, with Blood Stasis as the leading Syndrome Type.2. Qi Deficiency was consistently present pre and post-PCI, the procedure tends to relieve Blood Stasis but may aggravate Yin Deficiency and Stagnant heat resulting in Phlegm Turbidity.3. The results for this investigation suggests TCM treatment should pay attention to Strengthening Zheng, with particular emphasis on Promoting Qi and Nourishing Yin, as well as the prevention of Stagnant Heat and Phlegm Turbidity. Conversely, Promoting the Circulation of Blood and Dispersing Blood Stasis is not a main form of treatment at this point in time.