International Circulation: There have been changes in the way guidelines are made， with more use of hard evidence derived from randomized controlled trials and expert opinions for more specific recommendations. Do you the see AUCs as filling a gap left by the disappearance of older style guidelines?
　　Dr. Bailey: I do not think we are disseminating the information differently. The initial guidelines helped us identify where the initial gaps in knowledge were. We did not have trials that dealt with bifurcation or left main or particular areas. These guidelines give us the impetus to do that. There are philosophical differences in terms of how different societies approach how they use information. In the US， we have chosen to be data-driven when generating guidelines. Europe does not have an AUC process， but they do incorporate components of appropriate use into their guidelines. They do want to look at particular patient populations. As a scenario， they want to utilize that information to help people understand how their clinical practice， in certain instances， would be impacted.
　　《国际循环》：指南制定的方式已发生了变化，更多采用了来自随机对照试验的硬证据，专家意见更多针对特殊人群。您是否认为AUC能够填补老版指南这两种方式的差异？
　　Dr. Steven Bailey：我认为指南传播的方式没有什么不同。最初的指南帮助我们了解学术界的空白所在，那时我们没有处理分叉病变或左主干及其他特定领域问题的试验数据，指南给了我们开展这些试验的动力。不同学会对于如何利用这些信息存在着明显差异。在美国，我们选择以数据为基础制定指南。欧洲没有AUC程序，但他们的确将合理使用的成分纳入到指南中。他们想要观察特定的患者群体。作为一个方案，他们试图利用这些信息帮助人们理解其临床实践在一定情况下是如何被影响的。
　　International Circulation: What were some of the most memorable scenarios from the proceedings for the 2012 AUC?
　　Dr. Bailey: This is new for us， so we are still developing a reading on what it means. Where ever the information is provided and gathered， it looks similar. There are significant variations in care. However， the care we give for the most ill patients (STEMI and non-STEMI) is great and people do it well and are accordant and appropriate 95% of the time. When it comes to elective procedures， there is much wider variation. Here I am concerned and we may not be using the AUC enough. A paper published by Hough and colleagues suggests that patients clearly benefit from revascularization， when it is appropriate， as opposed to continued medical therapy. We do not know all of the reasons why they received continued medical therapy， but the fact that only 2/3s of people who were identified as having appropriate care got revascularized， makes us wonder about why 1/3 did not. Similarly， we are concerned about the inappropriate group in that same paper. The patients who received an intervention despite being in an appropriate category did not do as well. We need to understand more about this. Again， this is population-based rather than individual-based. It does serve as a framework for all of us in terms of our practice and even for hospital systems to evaluate what is going on. In the US and in the rest of the world， particularly in countries where this process is evolving， this forms the basis for them to quickly look at outcomes and help everyone that is performing these procedures， perform them better.
　　《国际循环》：2012年的AUC中哪些方案最有纪念意义？
　　Dr. Steven Bailey：这对我们是全新的，我们还在继续研读其要传递的信息。在治疗方面有显著的变化。然而，95%的情况下，我们对绝大多数急诊患者（STEMI和非STEMI）实施的治疗是非常有效的，患者反应良好。对择期手术患者，变化范围更大。我担心我们对AUC利用得不够。Hough及同事的文章提示，合理选择的患者接受血运重建治疗的获益大于药物疗法。我们不了解他们继续接受药物治疗的全部原因，但事实是仅2/3的被认定为合适的患者接受了血运重建，这使得我们提出疑问，为何另外1/3没有接受血运重建？同样，我们还担心这篇文章中的不合理治疗组患者，他们被分类为不适宜（PCI）却接受了介入治疗，而疗效不佳。对此我们需要理解更多。需要再次说明，这是基于人群而非基于个体的研究。这为我们的临床实践甚至医院系统评价所做工作提供了一个框架。在美国和其他地区，尤其是这些治疗正在兴起的国家，这构成了快速观察结果和帮助手术者更好实施手术的基础。