International Circulation: To select the best revascularization strategy for high-risk multivessel disease patients， we should consider all aspects of the patients， how would you suggest to balance the real-life perspective and evidence-based guidelines?
　　Dr. Capodanno: Guidelines are based on studies， which are performed in settings which are not those of real practice. It is a problem. Randomized control trials are quite selective. They exclude good patients that we commonly see in the practice. Guidelines should be followed， but you need to be flexible and you need to adapt the rules that you read in the guidelines to your particular patient. This is of course a key message.
　　Scores may assist you in identifying not only patients who are at high risk， but especially patients who are at low risk for a procedure. Patients for which there could be some overlap for the two procedures. For this group of patients， you can talk with the patient and get his opinion. I intended the guidelines for a group of patients with some equipoise between procedures. Of course this does not mean that simply have a number and below this number you treat and over this number you cannot treat. You have to flexible; you have to adapt the indications to your patient and for the best outcome.
　　《国际循环》：为了给高危多支病变患者选择最佳的血运重建策略，我们应当全面考虑患者的情况，您觉得应当如何平衡真实临床实践下的想法和基于循证的指南？
　　Capodanno教授：指南来自于临床研究，而研究并不是在真实临床实践情况下开展的。这是个问题。随机、对照试验的受试者是经过选择的，排除了我们在临床实践中常见的病情轻的患者。我们应当遵循指南，但是需要有一定的灵活性，我们需要使指南中的规则与特定患者的情况相适应，这是关键所在。
　　评分可能不仅仅会帮助我们检出高危患者，尤其能够发现接受手术的低危患者。有些患者可能选择CABG和PCI都可以，对这样的患者，可以跟患者交谈，听取患者的意见。我想指南是给患者用的，在两种手术方法之间寻求一定的平衡。当然这不是意味着只是简单的说设定一个数值，低于这个数值就治疗，超过这个数值就不治疗。医生应当有一定的灵活性，应当根据患者的情况选择手术，以获得最佳转归。

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