Keith Fox   英国爱丁堡皇家疗养院和心血管科技大学 教授

International Circulation: From 1999 to 2007， Global Registry of Acute Coronary Events (GRACE/GRACE2) gave us some data about thrombotic therapy in ACS patients. Would you like to assess these trials now?

《国际循环》：从1999年到2007年，急性冠脉事件的全球注册研究(GRACE/GRACE2)给我们提供了ACS患者血栓治疗的数据资料。您能否谈谈这些临床研究？

Professor Fox: The GRACE program was run from 1999 now to 2009 and what it has demonstrated is that there has been a big change in therapy over that time. The biggest change has been in the increased use of international therapy and anti-platelet agents as dual anti-platelet therapy， and antithrombotics. In the anti-thrombotic therapy， there has been a change from unfractionated heparin to LMWH and in the anti-platelet therapy， the main change is the use of clopidogrel plus aspirin and then in the high risk people glycoprotein IIb/IIIa inhibitors.

Fox教授: GRACE研究项目从1999年开始到现在2009年，治疗方面已经有了很大变化。最大的变化是抗血小板药物的使用率增加，比如双重抗血小板治疗以及抗凝治疗。抗凝治疗从普通肝素转变为低分子量肝素，抗血小板治疗方面的主要变化是使用氯吡格雷加阿司匹林，高危患者可使用糖蛋白IIb/IIIa抑制剂。

International Circulation: In your opinion， from the ESC and AHA/ACC 2007 guidelines for the diagnosis and treatment of NSTE-ACS， what is the most important change in anti-thrombotic therapy?

《国际循环》：根据2007年ESC和AHA/ACC诊断和治疗NSTE-ACS指南，您认为抗血栓治疗中最重要的变化是什么？

Professor Fox: Firstly， of the changes in anti-thrombotic therapy in these guidelines， I think the most important is ensuring all the patients get dual therapy when they arrive - in other words， dual anti-platelet therapy， aspirin plus a thienopyridine. The second thing is that the high-risk patients should also receive a glycoprotein IIb/IIIa inhibitor. The other important factor is the high-risk patients should go to intervention with PCI.

Fox教授:首先，指南中抗血栓治疗变化中最重要的是一旦收治此类患者，即应该确保让患者得到双重抗血小板治疗即阿司匹林加噻氯匹啶。其次，对于高危患者应该给予血小板膜蛋白IIb/IIIa抑制剂。另外重要的一点是，高危患者应予以PCI介入治疗。

International Circulation: As the bigger trial in treatment for ACS patients， what have we learnt from GRACE/GRACE2?

《国际循环》：GRACE/GRACE2有关ACS患者治疗更大的临床研究，我们从中能有何获益？

Professor Fox: The most important message from GRACE/GRACE2 is if we narrow the gap between the evidence and what is done， then outcomes improve - deaths were reduced， re-MI were reduced， heart failure was halved and bleeding went down. So it is good news if we follow the evidence. GRACE very closely reflects clinical practice as there were no exclusions， other than people less than 18 years of age which can’t be ACS and secondly if the ACS is secondary to anemia or trauma， so very few people are excluded.

Fox教授: GRACE/GRACE2最重要的信息是，如果能缩小循证医学证据与现实处理之间的差距，那么结果将会有更好的改善，包括减少死亡率、心肌梗死再发率、心力衰竭发生率，出血率也会下降。根据循证医学证据来处理的话，会有更多获益。GRACE研究非常真实的反映了临床实践，因为没有排除很多的患者。除了患者低于18岁不可能是ACS，或者继发于贫血或外伤的ACS患者之外，绝大多数ACS患者都能入选。