<International Circulation>: Could you speak briefly to the mechanisms of why statins are important post PCI?

　　Prof. Patrick: Yes as a matter of fact， statins are even interesting pre PCI.  There are a lot of studies in EXCEL we are insisting on having high dose of statins pre PCI， it is not clear how it works but it seems to have some impact on the acute procedure.  After the procedure it is mainly prevention and maybe a little bit of reduction or regression of the atherosclerotic process so what you see in all these studies like LEADERS， RESOLUTE， all these big studies is that you have more or less after 1 year， 10 to 15% of lesion related problems， something in the vessel that you have treated.  But there is another 10 or 15% which is in the other vessel so there is always progression of the disease and one of the big mistake of the community of interventional cardiologists is they consider themselves as premiers. I mean they have to treat the whole thing and they must have a holistic view of the patient so when you have atherosclerosis， you have to take care of the LDL.  For instance in the randomized trial that I am finishing on bioabsorbable scaffold versus Xience， I insist very much on that， I insist on the fact that we respect the guideline of the European Society and these guidelines say that the LDL must be below 1.8mmol.  At the onset of the study， only 30% of these patients were correctly treated and after 6 months， with all the action that we have， it is now 60% but it is not yet 100%.  So you still see people have these expensive biodegradable stent and all the beautiful stories about it， but they are learning with poisoning levels of LDL.

　　《国际循环》 :您能简单的谈一谈为什么他汀对与PCI术后患者非常重要吗？

　　Patrick 教授: 事实是他汀也可用于PCI术前。EXCEL中有大量的研究，我们坚持对PCI术前患者使用大剂量的他汀，虽然并不清楚他汀是如何起效的，但似乎它对能够对急性期患者产生影响。 PCI术后的主要治疗是预再狭窄和逆转或减少动脉粥样硬化形成。如LEADERS、RESOLUTE这些大规模研究所示，研究开始后1年左右，10%～15% 的血管内病变被治愈，但另外的10%～15%的问题又出现了，所以说病变总是处于进展状态，问题之一在于进行介入治疗的医疗机构首先考虑的是自己的利益。我的意思是他们必须全盘治疗且必须对患者的病情有一个整体观。当有动脉粥样硬化时，就应该关注患者的LDL水平。例如，在我完成的对比生物可降解支架和依维莫司支架疗效的随机研究中，我始终强调应遵循欧洲学会的指南中所推荐的LDL应控制在低于 1.8mmol。研究之初，仅30%的患者接受了正确的治疗，经过我们的努力，6个月后60%的患者得到了正确治疗，但这一比例仍无法达到100%。因此，你将看到，患者一边接受了价格昂给的生物可降解支架，一方面却仍存在着危险的LDL 水平。