<International Circulation>: Do you have any comments specifically towards Chinese or Asian patients when it comes to personalizing this therapy?

　　《国际循环》：您对中国或亚洲人群个体化治疗方面有什么见解？

　　Prof. Fox: Clearly there are different genetic profiles in ethnic groups around the world. We would expect that the difference are very well know among both Chinese and Japanese and many other Asian population that for example with warafirn， there are different requirements compared with western populations. This is an illustrations of good examples in difference in metabolism with a genetic basis.

　　Fox教授：很显然，世界上不同民族之间存在不同遗传特征。我们预期中国、日本和其他亚洲人群在用药方面也存在差异。例如华法林使用方面，亚洲人群和西方人群相比就存在不同。这是不同遗传基础药物代谢不同的很好例子。

　　<International Circulation>: Could you comment briefly on the TERISA trial in relation to type-2 diabetes patients? Will this relate to your practice?

　　《国际循环》：您能简要评论关于2型糖尿病的TERISA试验吗？这和您的实践是否有关？

　　Prof. Fox: At the moment， not. I think that the study was encouraging and it showed an impact on angina in those patients with diabetes. Interestingly， there was a decline in the frequency of diabetes in the run-in phase. This shows， there are some baseline changes and the impact of ranolozine was clearly shown. In my view， it wasn’t huge.

　　Fox教授：目前还没有。我认为这项研究令人鼓舞，显示了对糖尿病患者心绞痛的影响。有趣的是，在导入期，糖尿病患者心绞痛发作频率有所下降，显示有些基线改变。我个人认为雷诺嗪影响不大。

　　<International Circulation>: With the ROCKET AF trial and the use of rivaroxaban in AF， how do these new oral anticoagulants compare to warfarin in the prevention of stroke?

　　《国际循环》：关于ROCKET AF试验和房颤患者使用利伐沙班。这些新型口服抗凝药和华法林相比，在预防卒中方面效果如何？

　　Prof. Fox: I first have to declare that I am a co-chair of ROCKET AF， but my statement would be that all of NOAC， half the risk of intracerebral bleeding compared to warfain and that his been found consistently across the trials. The NOAC are either better than or equivalent to warfain in all the settings. In my view， the big advance is that peatinets who cannot tolerate， feel they cannot tolerate， or for whom it is inconvenient to obtain multiple blooding testing for INR， the new agents will have a substantial advantage. The problem is， world-wide， there are large numbers of people who are receiving anticoagulation. Some are receiving only aspirin. There was the assumption that aspirin was a safer alternative. We now know that the bleeding rate with aspirin is roughly equivalent to that o the NOAC and yet it is much less effective in preventing stroke. Aspirin is clearly not the answer， and that was shown in the AVAROS trial with apixaban. With the new agents， a larger proportion of people can be treated， and it is likely that there will be less problems with tolerance. This will allow people to remain on therapy for longer and decrease the evidence of stroke.

　　Fox教授：首先我必须声明我是ROCKET AF试验的联合主席之一。我的声明是所有新型口服抗凝药和华法林相比都可以减少一半颅内出血，而且所有试验结果都一致。在所有情况下新型口服抗凝药的效果都优于或等同华法林。我认为，最大的进步是不能耐受或不方便多次检查INR的患者来说，新型口服抗凝药可带来极大获益。问题是，世界范围内，有大量人群在接受抗栓治疗。有一些只服用阿司匹林。曾经有观点认为阿司匹林是较为安全的替代品。现在我们知道阿司匹林的出血发生率和新型口服抗凝药基本相同，但预防卒中方面的效果差很多。阿司匹林显然不是答案，和阿哌沙班对照的AVAROS试验显示了这一点。有了新型药物，更多人可以接受治疗，并且可能耐受性问题也较小。这能够允许人们更长时间维持治疗并降低卒中发生率。

　　<International Circulation>: What were some of your general impressions of the ACC this year? What were the most exciting results?

　　《国际循环》：您对本次ACC大会有什么总体印象？哪些试验结果最令人激动？

　　Prof. Fox: For me， there are two that will probably have a large impact on practice. The first is the STREAM trial which showed that pharmaco-invasive strategy where primary PCI. This was a pragmatic study in 2，000 patients in a population that were not able to get primary PCI within one hour， but still within 3 hours. Primary PCI was compared to tenectoplase， a lytic agent， given promptly， followed up by rescue PCI or delayed PCI in those that had evidence of reperfusion. The outcomes were comparatively similar. Around the world， there may be important applications for that. The other trial is the cangrelor trial (CHAMPION PHEONIX) which clearly showed to be superior to on the table administration of clopidogrel in the study that was undertaken.

　　Fox教授：对于我来说，有两个试验可能会对临床实践产生重大影响。第一个是STREAM试验，比较了直接PCI和药物-介入治疗策略。研究入选2000例患者，这类患者无法在1小时内进行直接PCI，而是在3小时内。直接PCI和溶栓药Tenecteplase对比。溶栓药即刻使用，随后对有再灌注治疗指征的患者进行补救PCI或延迟PCI。两种治疗策略结果相似。在世界范围内，这个研究结果有很重要的应用意义。另一个试验是关于坎格雷洛的试验（CHAMPION PHEONIX）。这个试验明确显示坎格雷洛优于氯吡格雷。

　　<International Circulation>: With concern to the STREAM trial， why was the pharmaco-invasive strategy not previously an option?

　　《国际循环》：关于STREAM试验，为什么药物-介入治疗策略过去没有成为选择？

　　Prof. Fox: The studies that have been done focused on primary PCI vs. thomoboylysis. Previously， that thormolysis was not followed up with any interventional technique to deal with original stenosis. In other words， they were facing many reocclusions in the fibrolytic arm， whereas this pharmaco-invasive strategy is two-stage: opening the vessel with the fibrolytic and then dealing with original stenosis. This is not done immediately in most patients and is instead done a day later.

　　Fox教授：过去关于直接PCI和溶栓治疗对照的研究中，溶栓治疗之后并没有进行任何介入治疗来处理原有狭窄。换句话说，在溶栓治疗组中会有很多再闭塞。而药物-介入策略则分两个阶段：使用溶栓药开通血管，然后处理原有狭窄。绝大多数患者并不会立刻进行介入治疗，而会在几天之后进行。