International Circulation: Dr. George Dangas and Dr. Run Lin Gao， thank you both for joining us at ACC 2009.The first question I would like to talk about today is regarding the SYNTAX trial. It’s really the first study to compare the best technology of percutaneous coronary interventions using drug-eluting stents with the best therapy provided by coronary artery bypass surgery in patients with triple vessel coronary artery disease and/or lesions of the left coronary artery trunk. What do you think about the results? How would you interpret the results as well? There seems there are some different viewpoints on how to interpret those results. First， Prof. Dangas.
《国际循环》：George Dangas教授和高润霖博士，感谢两位在此次会议上接受我们的采访。首先，关于SYNTAX研究，我想提个问题。它首次比较了在处理三支血管病变和（或）左冠状动脉主干病变中，使用药物洗脱支架行经皮冠状动脉介入术和行外科冠状动脉搭桥手术的优劣。你们对此结果如何解读？看起来对此结果，仁者见仁，智者见智。您二位对此有何看法？首先，Dangas教授您怎么看？

Prof. Dangas: This is an important matter and the subject is studied extensively in the SYNTAX trial in which the drug-eluting stent (predominantly TAXUS) is compared to bypass surgery. This was a one year follow-up study and right from that point of view we can understand that there will be valuable information about how patients do after these procedures but also their time limit is a bit too short. The main findings of the study from a clinical point of view were that death， heart attack and stroke rates were the same between the two strategies but the stent strategy needed more repeat procedures. That is， I think， expected in a population that has many vessels disease and many lesions. So from that point of view there was no surprise. I was also very interested in the findings of the left main part of that study and although it is a part of the study， it has so many patients; there are more patients in this substudy if you want than any other study of left main before. So I think the valuable end point was，  that in the left main patients with left main stenosis who are acceptable for PCI， the results are great. The other aspect that we understood very well is that if we use a rather complex， but at the same time， easily understood scoring system of how severe the blockages are， and how tortuous or calcified the coronary artery is， we can understand many lesions that are bad for angioplasty and stent， and therefore could be better candidates for surgery. So I think these are the three main points of the SYNTAX to me.
Dangas教授：这是个很重要的问题；在SYNTAX研究中，比较了药物洗脱支架（主要是TAXUS支架）和外科搭桥手术的利弊。这项研究随访时间为一年，仅从这段时间来看，我们清楚明白得知道了一些结果；遗憾的是随访时间太短。从临床来看，最重要的发现是两种处理措施后，死亡率、心脏病发病率、卒中率相似；但置入支架PCI组再次手术率高。在有多支病变和多发病变的人群中，这也是可以预料的，并不奇怪。同时，对左主干病变研究是SYNTAX研究的一部分，也很有趣，病例数很多，比以往的左主干研究都要多。所以，我认为左主干狭窄的左主干病变患者是否可行PCI术，此研究提供了很好的参考信息。最后，我们知道，若能有一个相当精细，但同时容易理解的评分系统，去评价血管闭塞程度，扭曲状况或钙化程度，我们就可以识别出很多不适合血管造影和支架置入的病变，而去给其外科搭桥。这是我认为的SYNTAX三大研究结果。

Prof. Gao: I fully agree with Prof. Dangas. The SYNTAX trial provides us with very strong evidence for the treatment of triple vessel disease and left main disease by PCI. Before that， there was no randomized trial to compare the drug-eluting stent and bypass surgery for left main disease or even triple vessel disease. Like Prof. Dangas indicated， the drug-eluting stent compared with bypass surgery gave us similar MACE rate but the only difference is PCI has a higher TVR rate. Another thing is bypass surgery actually has higher incidence of stroke than PCI. So if clinically， like Prof. Dangas indicated， if the lesion should go for PCI some left main selective level of disease could be treated by PCI， for example， if isolated left main disease or left main disease combined with one or two vessel disease I think they should be very suitable for PCI. That’s a good indicator because there are similar results with bypass surgery but like Prof. Dangas indicated， if the SYNTAX score is too high， a very high SYNTAX score is not good for PCI and you still should select CABG.
高润霖教授：我完全同意Dangas教授的意见。SYNTAX研究为我们给三支病变和左主干病变行PCI手术提供了有力证据。在此之前，没有随机研究来比较药物洗脱支架和外科手术搭桥对治疗左主干病变的优劣，更不要说三支病变了。Dangas教授刚才提到，药物洗脱支架和外科搭桥术相比，严重恶性心血管事件比率相同，但PCI术有更高的血运重建率，但外科搭桥卒中率更高。象Dangas教授指出的，临床上，若一些病变需行PCI，比如单独左主干病变或左主干病变合并一支或两支血管病变，我认为很适合做PCI术，同搭桥术相比，结果相同。但象Dangas教授刚才提到的，若SYNTAX评分很高，不适合行PCI术，还是需行外科冠状动脉搭桥手术。

International Circulation: In China， how has SYNTAX affected clinical practice? What’s been the feeling in general in the community in China and has it affected your practice?
《国际循环》：SYNTAX研究对中国的临床实践会产生什么影响呢？业界对此有何反应？

Prof. Gao: In China we have no software to calculate the SYNTAX score， but just say if the lesion is very diffuse， it is common to still recommend bypass surgery. I don’t know. Prof. Dangas， the SYNTAX score， do you routinely use in practice?
高润霖教授：国内目前没有计算SYNTAX评分的软件，但粗略得来讲，若病变很弥漫广泛，通常建议行外科搭桥。Dangas教授，你们在临床上SYNTAX评分用得多么？

Prof. Dangas: No， the SYNTAX score is actually very difficult to use in practice because there are too many variables but the idea of the SYNTAX score we take into account. So although I don’t know what the specific SYNTAX score is for any patient I think we can select the patients who are clearly high and clearly not so high score. I think maybe in the near future they will have a more practical score based on a computer that more people could calculate easily， but the point is not to know the exact score， it is the point to know if it is very high or rather low and I think that determination we can make based on tortuosity， calcification， how many lesions and total occlusions etc. As far as the practice side of things it has not affected that much because the message has been similar to what we have been doing all along.
Dangas教授：尚未临床应用；SYNTAX评分系统太过复杂，参数众多，不适合临床应用；但我们心中要有SYNTAX评分这个概念在。尽管本人不知道接诊患者具体SYNTAX评分多少，但很明显的SYNTAX评分高的或明显低评分患者还是可以区分的。也许不久，有人会开发出基于电脑的简易可行评分系统；此评分的目的不在具体的分数，而是在于帮助临床医生根据冠状动脉的扭曲程度、钙化情况、病变闭塞数目来评出SYNTAX高分或相对低分，从而做出临床决策。对临床实践的影响也不大，因为我们一直以来临床工作的理念与此评分系统相似。

Prof. Gao: We just use the concept.
高润霖教授：我们仅仅使用了此概念。
International Circulation: Perhaps applying the SYNTAX score in a very exact way is more a tool for research and useful in that way?
《国际循环》：或许精确SYNTAX评分更多得应用于科学研究，用途也更大？

Prof. Dangas: Definitely yes. And I want to tell you actually that we have a FREEDOM trial going on in the diabetic patients and we are going to record the results in a few years. In probably one year， we finish the enrolment， next year we will have some results， and this is in triple vessel disease in diabetics only with PCI and CABG and you should expect also the FREEDOM score of the trial specifically for diabetics.

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