International Circulation: Coronary artery bypass grafting (CABG) used to be the standard therapy of multivessel disease. Nowadays， PCI has made great advancement in revascularization， do you think PCI will replace CABG to be the optimal therapy for high-risk multivessel disease patients?
　　Dr. Capodanno: No， to be honest， I do not because you need some major improvement in the technique of percutaneous intervention in order to say that this replace CABG. What we see now is that the advantage of CABG over PCI is definitely superior. There is no doubt about this. The only patient that you can treat is those with low ..  This means a syntho score less than 22， but for all the other patients especially those with diabetes， those who are older， the advantage of CABG over PCI is definitely superior especially in terms of survival， which of course is a matter of concern.
　　We have started to see that even with second generation drug eluting stents， we do not achieve great results in diabetics …. So far I would not think that in the near future things will change dramatically， but we will need some major advances in PCI in order to think about that.
　　《国际循环》：冠状动脉旁路移植术（CABG）过去是多支病变的标准治疗。现在，PCI在血管再通方面取得了很大的进展，您认为PCI能否取代CABG成为高危多支病变患者的最佳治疗？
　　Capodanno教授：坦白讲，我认为不会。PCI技术还需要很大进展才能够取代CABG。目前看来，毫无疑问CABG优于PCI。只有低危患者才可以接受PCI治疗，即syntho评分低于22分的患者，但是对于其他患者，尤其是糖尿病患者和老年患者，CABG明显优于PCI，尤其是在生存率方面，而生存率是个需要关注的问题。
　　我们看到，即使是用第二代药物洗脱支架，在糖尿病患者还是没法取得很好的效果。目前我认为，在不远的将来这种情况不会有太大变化，PCI得有一些大的进展，我们才能考虑PCI替代CABG的问题。
　　International Circulation: Identifying the high-risk patients was the first step of choose optimal treatment strategy. How can we recognize high-risk multivessel disease patients?
　　Dr. Capodanno: We now have the advantage of having many scores that you can apply to understand who are the high-risk patients. Of course not every score represents something that you have to obtain to be sure that you have to treat the patient with CABG or PCI. They are only indicative. They give you advice on who are the high risk and the low risk patients for a procedure. Scores are quite useful in helping you drive your decision and also very useful for the patient. The patient now has the right to know his risk for a procedure and in order to get an informed consent， which is truly informed， it is the right of the patient and the families to have a standardized approach to risk.
　　I know that many interventionists think that the score is not quite useful. I think these scores can be helpful in decision-making， but of course they have to be scores that integrate both the clinical angiographic and functional information.
　　《国际循环》：检出高危患者是选择最佳药物治疗策略的第一步。如何识别高危多支病变患者？
　　Capodanno教授：现在我们的优势在于有很多评分系统，用于检出高危患者。当然，在决定患者是接受CABG还是PCI之前，并不是每一个评分都需要评测，评分只是用来参考，评分会提示我们接受手术的哪些患者是高危的，哪些患者是低危的。评分对我们做出治疗决策是相当有帮助的，对患者也是非常有用的。当前患者有权力知道他接受某种治疗时风险有多大，为了获得真正的知情同意，通过标准的方法被评价风险是患者和家属的权力。
　　我知道，很多介入心脏病医生认为评分没什么大用处。我认为，评分有助于医生的治疗决策，不过当然还得考虑临床血管造影结果和功能情况。
 

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