Ghent大学心内科 Thierry C. Gillebert

　　International Circulation: Your presentation at GWICC2011 is entitled “2011 ESC Non-ST-elevation myocardial infarction. Key points.” We know that patients with prior CABG surgery presenting with non-STEMI are thought to be at high risk. What are the new guideline recommendations for patients with prior CABG surgery presenting with STEMI?
　　《国际循环》：您在第二十二届长城国际心脏病学会议（GWICC2011）做了题为“2011 欧洲心脏病学会（ESC）非ST段抬高型心肌梗死（Non-STEMI）指南要点”的报告，我们知道冠状动脉搭桥（CABG）术后的NSTEMI患者属高危人群，那么对于此类患者指南有什么新建议呢？
　　Prof Gillebert: There is a list of what is high risk non-STEMI. If you have a high risk non-STEMI such as after CABG (but there are eight or nine other conditions where you have high risk)， the guidelines suggest early angiography and early intervention. Patients with previous CABG are better off if they are treated with coronary angioplasty early in the setting of the hospitalization. ‘Early’ means within 24 hours of the start of the infarction.
　　Gillebert：指南中罗列了NSTEMI患者的高危因素。如果为CABG术后的高危Non-STEMI患者（或是存在其它8-9项高危条件），指南建议早期血管造影和早期介入治疗。住院期间早期行冠脉内成形术，最好在梗死开始的的24小时内，则高危NSTEMI患者的预后会更好。
　　International Circulation: Looking at what is new in the ESC Guidelines， there are three new diagnostic guidelines: high-sensitivity troponin has been introduced; echocardiography as standard; and that consideration be given to coronary CT angiography， if available， as an alternative to invasive angiography.
　　《国际循环》：新ESC指南中有三个新的诊断准则：释义超敏肌钙蛋白；标准化超声心动图；以及冠状动脉CTA可作为替代侵入性血管造影的方案。
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　　Prof Gillebert: The availability of high-sensitivity troponin is something that has occurred in the last few months. High-sensitivity troponin gives you a very precise level of troponin and this level of troponin occurs in many chronic conditions such as chronic renal disease for instance. Superimposed on that， you have the acute condition. How do we use this high-sensitivity troponin? You have an initial value and unless this value is quite elevated， you await a second value which is taken three hours after the first. If you have a rise or fall in troponin， then you have an acute coronary syndrome with enzymes so you have non-ST elevation myocardial infarction. You can then move forward on this basis.
　　Gillebert：超敏肌钙蛋白应用是在过去几个月刚刚才开始，它的检测非常精确，在许多慢性疾病如慢性肾脏疾病中检测值也可升高，那么在紧急情况下，我们应怎样使用超敏肌钙蛋白呢？除非超敏肌钙蛋白的首次检测值非常高，医生们总会等待三个小时再抽取检测第二个值，结果升高或降低，存在肌钙蛋白升高的急性冠脉综合征就是NSTEMI患者，之后即可在此基础上进一步检查。
　　International Circulation: So this is going to speed up the diagnosis of acute coronary syndromes?
　　《国际循环》：是否可以说超敏肌钙蛋白加快了急性冠脉综合征的诊断呢？
　　Prof Gillebert: It will achieve two things: firstly that the diagnosis is more reliable than with the classical troponins; and secondly that it does speed up the process of diagnosis. The second troponin level is taken after three hours instead of six hours so the risk stratification has improved a lot with these high-sensitivity troponins.
　　Gillebert：实现了两件事：首先，超敏肌钙蛋白比普通肌钙蛋白的检测更加可靠；其次，加速诊断过程。普通肌钙蛋白一般等待6小时做第二次检测，而在超敏肌钙蛋白为3个小时，危险分层也因此提高了许多。

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