International Circulation: In ESC and ACC/AHA guidelines for anticoagulation in patients with non-ST elevation acute coronary syndromes， there is a significant difference in recommendation class for the use of an anticoagulant drug like unfractionated heparin， enoxaparin， or . What is your opinion about this situation?

Prof. Marco: Well in the ESC guidelines we have taken into consideration the bleeding risk and for the first time in the ESC guidelines we know for a fact that for patients in the bleeding group， the long term mortality is higher so this explains the two guidelines. 

International Circulation: Do you anticipate now with these ESC guidelines taking that into account? Do you think there might be a change in the American guidelines as well?

Prof. Marco: I do not know if they have already changed their guidelines but we recommend  just for the risk of bleeding.

International Circulation: And again， also in regards to guidelines. In the 2007 ACC/AHA and the 2008 ESC guidelines for ST elevated myocardial infarctions， it is not recommended for  to be used in primary PCI. So why is it? Is it due to lack of positive evidence or presence of adverse effects?

Prof. Marco: It is mainly due to the risk of thrombus formation during PCI with  use. That was the main reason in the trial and because of the lack of evidence for STMI.

International Circulation: Which trials were significant in that decision? Any results from particular trials in this case?

Prof. Marco: We do not have a trial positive for fondaparinux use in such situations. 

International Circulation: So really there is a lack of evidence for that situation. What is your opinion about distal embolic protection in acute coronary syndromes? Is it necessary?

Prof. Marco: If we speak about distal protection， we don’t believe it is necessary because the results of the different studies in acute coronary syndromes are a little bit confusing. We are in favor of thrombus aspiration for STMI because manual thrombus aspiration shows positive result but not a protective device.

International Circulation: Are there any plans that you know of for trials to follow up in this area? What is being done in any research in this particular area?

Prof. Marco: Of course there is place for new trials in order to try and demonstrate evidence for using protective device. At present time， the results are not enough.

International Circulation: What about patients with non-ST elevation ACS? Should they receive interventional treatment as early as they can? At what point? What is the time frame on that? 

Prof. Marco: Different trials show that if we do intervention very early， the results are acceptable compared to postponing the intervention. But on the other hand， the graph registry shows that the risk is higher with very early intervention， so we have to find the balance between very early emergency intervention and intervention after a bit of preparation.

International Circulation: Can you give us a little introduction or perhaps we could say a preview of EuroPCR which will be coming up soon in Barcelona. With your role in that meeting as president， can you give us a little insight as to what we can expect? 

Prof. Marco: I am the chairman of EuroPCR. EuroPCR is the official meeting of European Association of Percutaneous Cardiovascular Interventions and affiliate branch of European Society of Cardiology. The concept of EuroPCR is based on live demonstration around patients to show and to try and discuss what the best is for each individual patient. Then the real goal is to base our reasoning on evidence based medicine of course， but most importantly we hope to build good judgment for each individual patient in this convention.

International Circulation: And what will be some of these key areas that will be focused on this year?

Prof. Marco: This is a large program. One part of the program is dedicated to trans aortic valve implantation because this is a new technology and the results still need to be discussed but it is a new field need to develop. Then on the other hand， on the coronary field we will mostly discuss after the after results of SYNTAX and FAME trials for patients with multivessel disease. Also we will focus more on very elderly patients because it is more and more frequent in Europe and it is probably a group of patients that we have to take into consideration since most of these patients are excluded from randomized clinical trials.

International Circulation: Many countries are experiencing aging populations.

Prof. Marco: With very elderly patients， sometimes it is confusing about the definition.  What is a very elderly patient? But we try to focus on very elderly patient because for the future it is probably a very important point.

ACS的抗凝治疗

针对非ST段抬高ACS的抗凝治疗，ESC和ACC/AHA指南对普通肝素、依诺肝素和磺达肝癸钠等抗凝药物的推荐级别明显相同。ESC主要考虑到抗凝剂所导致的出血风险，同时ESC首次提示，有出血风险的人群其长期死亡率更高。ESC对磺达肝癸钠的推荐也主要是出于对出血风险的考虑。

2007 ACC/AHA和2008 ESC指南不推荐磺达肝癸钠用于ST段抬高的心肌梗死患者的直接PCI，主要是考虑到磺达肝癸钠应用所致PCI过程中血栓形成的风险，而且目前还缺乏磺达肝癸钠在STMI中应用的证据。

辅助机械装置在ACS中的应用

远端保护装置并不是ACS所必需的。因为针对ACS的不同研究的结果并不一致，令人困惑。但支持对STMI患者进行血栓抽吸，因为人工血栓抽吸已经获得了阳性结果。目前该领域的试验证据尚不足，尚待新试验去尝试和进一步验证。

非ST段抬高ACS的介入治疗时机

有研究显示，极早期开展的介入手术与延期介入手术相比，其结果是可以接受的。但另一方面注册登记的结果显示，极早期介入治疗风险较高。因此尚需要在延期和极早期急诊介入治疗之间寻找平衡点，确定最佳时间窗。

巴塞罗那EuroPCR会议预览

EuroPCR是欧洲心脏病学学会（ESC）分支机构欧洲经皮心血管介入协会（EAPCI）的官方会议。EuroPCR今年的内容仍是基于手术直播，来显示或尝试及讨论针对每个病例的最佳方案。在基于循证医学推理同时，会议召开的真正目的是希望在大会上为每例患者做出个体化的良好的判断。

今年EuroPCR主要关注的领域一个是经导管主动脉瓣移植方面，因为这是一项新技术也是尚待发展的新领域。在冠状动脉疾病领域，将就针对冠脉多支血管病变的SYNTAX研究和 FAME研究后续结果进行探讨。另外，因为欧洲的老龄化问题，EuroPCR还将给予老老年患者群体更多的关注，因为这一群体中的大部分患者是被排除在随机临床试验之外的。虽然老老年患者的定义未完全确定，但将来它可能是非常重要的一点，这也是EuroPCR尝试关注这一人群的初衷。