<International Circulation>: How much do you try to use data to affect the patient’s preference?
　　Dr. Stone: It is essential for the physician to be the patient’s advocate. The patient preferences are front and center as to how they should be treated. That being said， patients do not always have the medical knowledge to truly understand evidence-based medicine and when there is absolutely one therapy that is much better than another then it is the physician’s strong duty to do everything they can to try to convince a patient that it is in their best interest in undergo that particular therapy. There are other therapies where it is a matter choice， or where one therapy is a little better than the other， or there is clinical equipoise， then of course the patient should be fully informed of the pros and cons of each therapy. In this situation， this would involve a discussion with both an interventional cardiologist and the cardiac surgeon and then the patient’s preference should be dominant. I think it does depend a lot on how strong the evidence suggests that there is clinical equipoise， versus a slight preference， versus a very strong preference. This will give the best outcome.

　　《国际循环》：您如何利用这些数据去改变患者的倾向性？
　　Stone博士：医生的原则是要做患者的代言人。关于如何治疗，患者的选择应居于中心地位。但是，由于患者通常不具备真正理解循证医学所需的医学知识，当一种治疗显然优于另一种时，医生有义务尽全力去让患者相信采用这种治疗是最佳选择。其他一些治疗，有的是一种重要选择，有的是一种疗法相对于另一种存在些微优势，有的疗效相近，这些情况下应充分告知患者每种疗法的利与弊，讨论应包括介入心脏病医生和心脏外科医生，如此才能最终形成以患者意向为主的治疗决策。我认为这在很大程度上取决于提示疗效相当、存在些微优势、强烈建议的证据强度。这样作出的决定才能带来最佳的结局。

　　<International Circulation>: Right now， EXCEL is trying to show superiority of PCI over CABG. Is this for low and intermediate SYNTAX scores?
　　Dr. Stone: The EXCEL trial is 2600 patients with left main disease and either low or intermediate SYNTAX Scores—less than or equal to 32—and they being randomized to current state-of-the-art drug eluting stents with Xience Prime， everolimus eluting stents versus bypass surgery. The primary endpoint is death， MI， or stroke and an intermediate follow up of three years. It is first designed to show non-inferiority in PCI versus CABG. If it first proves non-inferiority， then it will go on to test for superiority. Clearly， if PCI is non-inferior to CABG， then it will be the most commonly selected strategy as it is less invasive and has less morbidity in the short term.

　　《国际循环》：当前，EXCEL试验正在试图证明PCI疗效优于CABG，这一假设是针对低-中SYNTAX积分的病变吗？
　　Stone博士：EXCEL试验纳入2600例低-中SYNTAX积分（≤32）的左主干病变患者，随机分组分别接受当前最先进的Xience Prime依维莫司洗脱支架或旁路手术，主要终点为死亡、MI或卒中，中位随访3年。这是第一项被设计显示PCI相对于CABG非劣效性的试验。如果该试验首次证实非劣效性，将继续进行下去进一步检验优效性。显然，如果PCI不劣于CABG，那么就将成为最常选用的策略，因为PCI更微创、近期并发症发生率更低。