<International Circulation>: In other words， the trial revealed that prasugrel had fewer total ischemic events than clopidogrel. How do you interpret that?
《国际循环》：换句话说，TRILOGY试验显示普拉格雷组的缺血事件发生率低于氯吡格雷组。如何解释这一结果？
Dr. Neumann: It is a secondary endpoint. Based on the pharmacology and on TRITON， I am convinced that prasugrel is a very potent drug and that， in many instances， prasugrel is superior to clopidogrel. However， the trial design prevented the potential of prasugrel to come to life. It is not a problem of prasugrel; it is a problem of patient selection. I do not think that the study is negative because prasugrel is not superior to clopidogrel. I think the study is negative because it was done in the wrong patients. They pushed the investigators very hard to not perform revascularization. In my view， that was a mistake. If the patient needs revascularization and the doctor withholds it， then prasugrel will not help. But， if the patient needs revascularization and receives it， then prasugrel will be very effective， as we have seen in TRITON.
　Neumann博士：这是次级终点的结果。基于药理学特性和TRITON试验的结果，我确信普拉格雷是一个非常强的抗血小板药物，在很多情况下，普拉格雷优于氯吡格雷。但是，TRILOGY试验的设计阻碍了普拉格雷潜在优势的显现。这不是普拉格雷的问题；这是患者选择的问题。我不认为由于普拉格雷不优于氯吡格雷，那么试验结果就是阴性的。我认为由于选择了错误的患者群，试验才是阴性的。在我看来，这是个错误。如果患者需要血运重建并接受了血运重建，普拉格雷会非常有效，正如TRITON试验所证实的那样。
<International Circulation>:At the end of the day， we know that prasugrel may not be suitable in medically treated patients?
《国际循环》：最后我们能否说普拉格雷不适合单纯药物治疗的患者？
Dr. Neumann: I would not go so far. I would say it is not suitable in medically treated patients if you withhold revascularization at any cost. This is my impression from the TRILOGY trial. If you look at just the conservative arm of PLATO， 40% of the patients had revascularization， despite  the fact that a conservative approach was decided beforehand. If you then look at TRILOGY， only 7-8% has subsequent revascularization. If you are so strict with revascularization， prasugrel cannot help you. I would assume that any potent P2Y12 receptor antagonist will not help you.
　Neumann博士：我认为不是。如果无论什么情况下都不进行血运重建治疗的话，那么可以说普拉格雷不适合单纯药物治疗的患者。我是从TRILOGY试验中得出上边的看法。对于PLATO试验的药物治疗组，40%的患者接受了血运重建治疗，尽管事先已经决定给予药物保守治疗。对于TRILOGY试验，只有7~8%的患者随后接受了血运重建治疗。如果对血运重建要求这么严格的话，普拉格雷也不会帮到患者。我觉得任何强效的P2Y12受体拮抗剂也不会帮到患者。
<International Circulation>: What is the take home message from the TRILOGY trial?
《国际循环》：TRILOGY试验有哪些关键的启示？
　Dr. Neumann: My take home message is to go with the guidelines for treating patients with ACS. For most cases， this is revascularization. If you go to these patients， then we have very good evidence that prasugrel is superior to clopidogrel.
Neumann博士：我们要遵循指南来治疗ACS患者。对于大多数患者来说就是血运重建。如果治疗这些患者的话，我们有很充分的证据证实普拉格雷优于氯吡格雷。

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