<International Circulation>:  Stratification and treatment strategies for patients with multivessel disease remain a major challenge. What factors are important when we decide which patients should undergo either coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI)?
    Dr Aaron Kugelmass:  The factors which favour bypass surgery will include reduced left ventricular function and significant complex coronary anatomy. The SYNTAX Trial is showing us that low risk patients from an anatomic and angiographic perspective show no advantage with bypass surgery and in fact it might increase slightly the risk of stroke.  But for patients with complex anatomy particularly those who have got this problem for an extended period of time say three years there seems to be an advantage for bypass surgery as opposed to PCI. Not all multivessel diseases are the same the procedure has to be individualized to suit the patient’s needs. 

  《国际循环》：多支病变患者的危险分层和治疗策略仍然是我们的主要挑战。在决定患者应当行CABG还是PCI时，哪些因素是重要的？
    Kugelmass教授：支持患者行CABG的因素包括左室功能障碍和非常复杂的冠脉病变。SYNTAX试验显示，从解剖学和血管造影来看的低危患者行CABG并无优势，实际上可能轻度增加卒中风险。但是对于复杂冠脉病变患者，尤其是病程较长者（例如3年），CABG看起来优于PCI。多支病变的情况各不相同，应当针对患者的需要进行个体化治疗。
    Dr Aaron Kugelmass serves as the division Chief of Cardiology at Baystate Medical Center Massachusetts and was an invited guest speaker at the Great Wall international Meeting of Cardiology.