<International Circulation>: Moving to STEMI， what are some of the main clinical controversies in its management?

　　《国际循环》:回到ST段抬高心肌梗死（STEMI）话题，临床上有关STEMI管理的主要争论是什么？

　　Prof. Henry: It is remarkable what has happened throughout the world in the last 10-15 years. Clearly we know that primary PCI is the preferred treatment for STEMI. The magnitude of the benefits is beyond what we thought. It is being organized across countries. England has changed from basically a lytic stragety to a PCI strategy with remarkable results. Central Romania is another example with a dramatically decreased mortality. These are a major change for the natural history of STEMI. What are the challenges? The challenges are to continue to organize and developed systems of care that regionally treat STEMI. It is not just important to treat well at PCI hospitals， but that we triage to PCI hospitals and we transfer people who present to non-PCI hospitals. This needs to be done in a coordinate manner. When we had a paper from the RACE project that specifically talked about the challenges. We need to develop regional STEMI systems of care. I would even go beyond that to suggest regional systems for acute CV emergencies. We cannot stop at STEMI， we need to advance that to acute aortic dissections， out-of-hospital cardiac arrest with cooling program and good resuscitation techniques， abdominal aortic aneurysms， non-STEMI， stroke， and critical ischemia. All CV emergencies need organized systems of care.

　　Henry教授:过去10~15年，全世界在STEMI管理方面取得卓越成就。STEMI患者首选PCI治疗，这一点已明确。而PCI带来的获益远超我们想像，许多国家都在PCI治疗。英国以PCI替代基本溶栓治疗，取得显著效果。罗马利亚则是另一个明显降低STEMI死亡率的范例。这是STEMI治疗史上重大改变。目前我们面临的挑战是持续有组织地发展地方性STEMI患者护理系统，不仅有利于那些具备PCI能力的医院更好地治疗，也有利于对患者分诊，从无PCI能力的医院向具备PCI的医院转运。要做到这点需对既往治疗方式调整。我们有一篇关于RACE项目的文章专门讨论将要面对的挑战。我们需要发展区域性STEMI护理体系，我甚至还建议发展针对急诊心血管疾病的地区系统。在主动脉夹层、伴随降温疗法和良好血运重建的院外心脏停搏、腹主动脉瘤、非STEMI、卒中和重症局部缺血等处理方面仍需进一步探索，所有心血管急症事件均需有组织、系统性的护理。

　　<International Circulation>: How do you identify these patients to get them to the right type of care?

　　《国际循环》:如何为这些患者选择正确的护理方式？

　　Prof. Henry: If I can use our model from the Minneapolis Heart Institute， we now have agreements with 35 community hospitals throughout Minnesota and Wisconsin as well as 10 clinics. You work with each one to have a standardized protocol in place so that if a patient presents at any one of these institutions and receives a quick EKG， preferably with the paramedics， and then that activates the system. There is a standardized protocol in terms of how the patients are transferred， which adjunctive medications they are taking， blood-draws， everything is standardized. Once you recognize STEMI on EKG， the system is triggered. We are nearing on 4，000 patients treated with this network over the last nine years. The results are phenomenal. It has been translated and transferred. In a paper we published in the American Journal of Cardiology last year， the same system in Iowa produced the same results. The point is that it is a function of the system using a standardized protocol with prearranged transfer plans.

　　Henry教授：也许我能应用来自明尼阿波里斯市心脏研究所的护理模式。目前我们已与明尼苏达州的35家社区医院和威斯康星州的10家诊所达成一致。我们与每位持有标准协议的患者合作，保证他们在上述医疗机构就诊时能得到快速的心电图检查、良好的护理，之后迅速启动系统。关于如何明确需要转诊的患者，将被送到哪家医院，进行何种血液检查，我们均有标准协议。一旦心电图提示STEMI，系统就被激活。过去9年，近4000例患者通过这一系统得到救治，成果显著。这种模式已被推广到更多医疗机构。去年我们在American Journal of Cardiology上发表文章，阐明这种模式在爱荷华州取得同样效果，重点介绍了配备预先转运计划的标准化协议系统。

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