《国际循环》：近年来，稳定性缺血性心脏病（SIHD）的管理日益受到关注与重视，美国及加拿大等国的学术机构分别更新了SIHD诊断与管理指南。透视上述最新指南，面对高危SIHD患者我们应如何进行管理与治疗？如何在最佳药物治疗、CABG及PCI治疗之间进行选择？

　　International Circulation: In recent years， the management of stable ischemic heart disease (SIHD) has attracted more and more attention. Thus the academic institutions of the United States， Canada and other countries updated their diagnosis and management guidelines for SIHD. According to these guidelines， how should we manage and treat high-risk SIHD patients? How should we make the choice between optimal medication， CABG and PCI?

　　Patrick O’ Gara教授：稳定性缺血性心脏病的管理有以下几个要点。第一，重中之重是预防，帮助患者坚持推荐的饮食、运动、戒烟及减重等生活方式干预。第二，确保患者服用能降低其二次事件发生率的他汀类药物及阿司匹林。第三，只有在患者经药物治疗无法有效控制其心绞痛，才能选择进行血运重建。第四，通常情况下，冠状动脉疾病越严重，患者症状越严重，心功能下降越显著，与PCI相比，采用CABG治疗患者的临床结局更好。就血运重建的选择而言，疾病越严重，与PCI相比，采用CABG治疗的结局越好。

　　Dr Patrick O’s Gara: There are a few messages concerning stable ischemic heart disease. One， it is all about prevention. It is all about helping our patients adhere to lifestyle recommendations for diet， exercise， smoking cessation and weight loss. Secondly， it is about making sure they take medications that have been shown to help reduce the incidence of second events， namely statins and aspirin. Number three is that it is important to realize that before choosing revascularization， patients should generally fail an attempt to manage their angina with medication. Fourthly， it is commonly understood that the more severe the coronary artery disease， the more severe the symptoms and the more severe the reduction in heart function， the better the outcomes that are achieved with CABG compared to PCI. For choices for revascularization， increasing levels of disease usually equate to better outcomes with CABG compared to PCI.

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