<International Circulation>: You talked about primary PCI and shock in your presentation today. One of the important points you made there was the necessity for extremely quick door-to-balloon times. Can you explain why this is important for shock?

　　《国际循环》：您今天在大会上谈到了直接PCI和休克。你谈到在这个时候最重要的一点是极快的入院至球囊扩张时间的必要性。您能谈谈尽可能快的入院至球囊扩张时间对休克的重要性吗？

　　Dr Mehta: Most of it has to do with how the patient with an acute MI progresses. As the time course of the progression increases， the patients who present late are the ones who have proceeded on to pre-shock and shock clinically. When you examine their infarct-related vessels you also realize that thrombus which is generally very dynamic has adopted a more difficult morphology for treatment. It is easy to treat red friable thrombus which can be treated with simple aspiration. But as the time has progressed and the patient has gone into shock， not only are you dealing with a patient who is clinically sicker and will probably require intra-aortic balloon pumps and other inotropes and have a very difficult management， now in the cathlab you are dealing with a denser more-organized thrombus which is something you are not going to be able to treat easily. My short-term message is that probably the most relevant is that you have to work not only at the door-to-balloon time but at the patient’s true ischemic time. As soon as a patient has chest discomfort and is able to access the system， it is that that truly impacts rather than just the door-to-balloon time which may be a false indicator depending on how the patient presents and where they present. At the end of the day， if you are going to deal with the situation where STEMI interventions and primary PCI go beyond interventional cardiology and the cathlab， there are public health issues in which there are numerous stakeholders from general physicians， to interventional cardiologists， to a hospital that has to provide an environment to help administration and government offices to create an ambulance system and a public health education methodology. Finally there is going to be a large role for the societies so that they might educate the patients.

　　缩短缺血时间才是关键
    这与急性心肌梗死患者病情的进展情况有关。在病情进展加重的时间过程中，那些入院较晚的患者已经开始进入休克前期或出现休克的临床表现，这时你要处理的患者不仅临床症状很重，而且很可能需要主动脉内球囊泵和其他血管升压药，治疗起来就非常困难，这时在导管室你面对的就是一种不可能简单处理的密度更高结构更紧密的血栓。我的观点是处理这种情况时最主要的问题可能不仅是需要努力缩短入院至球囊扩张时间，还需要努力缩短患者真正缺血的时间。一旦患者出现胸部不适症状就应该马上就诊，这比入院至球囊扩张时间更具有实际的意义。 

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