International Circulation:New clinical trials and registry studies have showed that the benefit of drug-eluting stents in terms of restenosis is not achieved at the expense of a compromised safety. What’s your opinion on the issue? Do you think the controversy over the safety of DES compared to BMS could be settled by current data?《国际循环》:新的临床试验和注册研究结果已经显示,因为安全性的问题,药物洗脱支架(DES)没有取得对再狭窄的益处。请问您对这一问题的看法如何?您认为当前的研究数据能够解决DES相对于裸金属支架(BMS)的安全性争论吗?
International Circulation: Interventional cardiologist might feel a little disappointed by the published SYNTAX trial results. Could you please comment on the results? Do you think it will have a major impact on the strategy selection in treating patients with multi-vessel or left main coronary diseases?
《国际循环》:介入心脏病医生可能对已发表的SYNTAX 试验结果有点失望。您能评价一下这些结果吗?您认为它将对多血管病变或左主干病变患者的治疗策略选择产生重大影响吗?
Mark Turco: The SYNTAX trial, from an interventionalist’s standpoint, was a very nice trial for us to see the results of, not discouraging. The SYNTAX trial gives me further data to go back to my patients to speak about the risks, benefits, and alternatives. What we have learned though from SYNTAX is that we do need to pay attention to the SYNTAX score. Those patients in the low to medium range actually do very well with angioplasty versus bypass surgery. It is those patients in the higher SYNTAX group that do worse, and it is those patients who may be better off with surgery. Furthermore, this was a very complex patient population that was treated, one of the most complex patient populations ever. On average, 4.64 stents per patient were implanted in the interventional arm of the trial. Just from that standpoint alone tells you that this was a complex patient population. To see the results and to see that there were not major deficiencies, with the exception of repeat revascularization, I feel pretty good about that information. I feel it wasn’t a disappointment at all, we know now that we need to learn more. The FREEDOM trial coming down the pipe will give us a lot more information about the diabetic subgroup.
Mark Turco 教授:从介入治疗医生的角度看,SYNTAX试验是一项非常令人激动的研究,我们看到这样的结果并不感到失望。SYNTAX试验为我们提供了更多的数据,我以后可以给我的患者更多解释复杂的多血管冠脉疾病治疗的危险、获益和可选方案。我们从SYNTAX试验获得的重要内容就是,我们需要关注SYNTAX评分。那些低危或中危的患者确实可以从血管成形治疗中获益,效果优于冠脉旁路移植术。而那些SYNTAX评分较高的患者人群采用血管成形治疗的效果不佳,他们可能从冠脉旁路移植术中获益更多。另外,SYNTAX试验所治疗的患者人群非常复杂,可能是迄今最为复杂的患者人群之一。试验中介入治疗组的患者平均每人植入4.6个支架。单从这点来说,它就告诉你这项研究有一个复杂的患者人群。血管成形组的结果不存在除多次血运重建之外的重大缺陷,我认为这是相当好的消息。这样的结果一点也不令人失望。我们现在意识到我们需要学习更多知识。FREEDOM试验将会为我们提供更多的有关多血管病变的糖尿病患者亚组的数据。我们也需要继续评价左主干病变患者人群,了解对这一复杂患者人群的最佳治疗方案。