<International Circulation>: Currently， when you suggest PCI over CABG for left main disease?
　　Dr. Stone: Currently， surgery is the gold standard for left main disease. PCI should be considered for acute MI as a life saving situation. Based on the current data we have， it is reasonable to consider PCI for left main disease outside the frame work of a clinical trial when the risk of PCI is extremely low and the long term results tend to be favorable， that is patients with low SYNTAX scores. Ostial left main disease， midshaft left main disease without any other lesions of the coronary tree， and the morbidity and mortality associated with bypass surgery will increase. For most patients， the guidelines still recommend surgery. I think this reasonable even though surgery is associated with a higher risk of stroke. The real unknown is whether this is relevant to mortality or the MI rate with the appropriate type of patients or those with low to intermediate SYNTAX scores. That is where EXCEL shines.

　　《国际循环》：就目前而言，您认为对哪些左主干病变患者应优先选择PCI而非CABG？
　　Stone博士：当前，外科手术仍是治疗左主干病变的金标准；PCI应视为急性MI抢救生命的一个选择。基于当前的证据，在临床试验的框架之外，对于左主干病变只有当PCI风险显著较低、且远期疗效趋势较好时，也就是低SYNTAX积分的患者，考虑PCI治疗才是合理的。无冠状动脉其他部位病变的左主干开口、中段病变，以及旁路手术相关的致残、致死率升高，（都可以考虑PCI）。对多数患者，指南仍建议外科手术治疗。尽管卒中风险较高，我仍认为手术是合理的。真正未知的是其是否与适当类型或低-中STYTAX积分患者的死亡率或MI发生率相关，这也是EXCEL试验的闪光点所在。

　　<International Circulation>: When can we expect results from EXCEL?
　　Dr. Stone: It was randomized approximately now in about 100 patients， so it will take a year to get to 2600 and then three years follow up. It will be about four years away.

　　《国际循环》：预计何时能够获得EXCEL试验的结果？
　　Stone博士：现已随机化约100例患者，还需要1年时间入选2600例患者，然后是3年的随访。大概4年后我们可以看到结果。

　　<International Circulation>: There is a lot of concern about late stent thrombosis， could you tell about what kind of treatment would you suggest to address these concerns?
　　Dr. Stone: The rate of late stent thrombosis is decreasing and the current generation of drug-eluting stents has shown that rates of late stent thrombosis is low. You are probably dealing with odds of 1 or 2 out of a thousand people with the current generation. Of course， there are studies going on， most particularly the DAPT study， to see if long term， dual antiplatelet therapy makes a difference， compared with discontinuing it after 12 months， and within a couple years we will have the result of that study. Right now， I would not be overly concerned about late stent thrombosis. Patients need to understand that it is a risk， but when you have coronary disease， there will always be risks. The risk of an MI or sudden death once you have the diagnosis of coronary disease will never go away. This is just one other thing to consider in the mix and not be overly obsessed with that complication.

　　《国际循环》：晚期支架内血栓形成仍是令人担忧的问题，您对处理这一问题有何建议？
　　Stone博士：晚期支架内血栓形成的发生率已有所降低，当前新一代药物洗脱支架已显示极低的晚期支架内血栓形成发生率，每1000例患者中可能发生1~2例。当然，还有多项研究正在进行中，其中主要是DAPT研究，旨在观察长期双重抗血小板治疗与12个月后终止DAPT疗效有无差异，我们将在数年内看到这些研究结果。就目前而言，我不会过度担心晚期支架内血栓形成的问题。患者需要理解这是一种风险，但当你罹患冠心病后，就永远面临风险。一旦被诊断出冠心病，那么MI或猝死的风险便永远不会消除。这是我们应该考虑的另一面，而不是沉溺于对该种并发症的过度担忧。