International Circulation: Another new point is the timing of revascularization. How has that changed?
　　《国际循环》：另一个新问题是血运重建的时间，这将如何改变呢？
　　Prof Gillebert: The philosophy in the past was if you have non-STEMI you need first to cool it down. When you cool it down， you have less risky interventions. Now we can see that the higher the risk is， the earlier you have to intervene. To simplify， the default for lower risk non-STEMI is that you should have a coronary angiography and intervention within 72 hours. If you have one of the conditions considered as a higher risk， and that is not only after CABG as we discussed earlier， but with a GRACE risk score >140 or with diabetes， intervention should be performed within 24 hours. There is a substantial difference between now and the past. In the past we would roll the non-STEMIs over to the next working day. Today this will no longer be possible over a weekend. Non-STEMI high risk patients will have to undergo intervention within that 24 hour time frame. The last condition is the unstable patient because there is a small category of non-STEMI patients who are unstable; for instance， if they have changes in ST-segment elevations or depressions， if they have severe rhythm disturbances， if they have hemodynamic problems and failure， then they need to go straight to the cathlab similarly to STEMI.
　　Gillebert：NSTEMI患者的治疗，过去理论是需要先冷静下来，择期介入治疗风险较低，而现在则是建议风险越高，越早进行介入治疗。简单来说，低危NSTEMI患者建议在72小时内行冠脉造影及介入治疗；而高危NSTEMI患者，这里不仅指CABG术后而是包括我们先前提到的GRACE风险评分>140或患有糖尿病的患者，介入治疗应在24小时内完成。现在和过去有着本质的区别：过去，我们会安排NSTEMI患者在下一个工作日进行冠脉造影及介入；而在今天，不会再拖过一个周末，高危NSTEMI患者将在24小时内进行介入治疗。最后还有一种情况是一小类不稳定的NSTEMI患者，如果存在ST段抬高或压低的变化、恶性心律失常以及血流动力学不稳定的状态时，此类NSTEMI患者需要同STEMI患者一样直接进入导管室。
　　International Circulation: In China， non-STEMI patients are generally transferred from smaller hospitals to a tertiary hospital. Is this the practice in Belgium and what are your thoughts on that?
　　《国际循环》：中国的NSTEMI患者一般是由一级、二级医院转诊到三级医院，在比利时是怎样的情况呢？您对此有什么想法呢？
　　Prof Gillebert: This is the practice in my country as well. You have to realize that you have to perform good interventions particularly in the setting of myocardial infarction and you need experienced teams. These teams have to be available 24/7. You cannot do that in every hospital. In STEMI， in the majority of cases， there is time in order to delay the intervention as long as it is performed within 72 hours as the default. It needs to be within 24 hours for high risk patients and it will always be an urgent situation if the patient is unstable. This means for all of these patients， transfer is feasible and possible and is not harmful. It is better to have bigger experienced centers than more readily available centers because in smaller， less experienced centers， the outcome for interventions is much poorer.
　　Gillebert教授：我的国家也同中国一样。必须认识到我们需要优秀的、经验丰富的介入治疗团队，特别是在心肌梗死患者的抢救过程中。这些团队必须时时刻刻准备着，每周7天、每天24小时待命，不可能每一个医院都具备这样的条件。在大多数情况下NSTEMI患者的治疗时间延迟，往往是因为我们默认只需在72小时内进行介入治疗，事实上高危患者或不稳定患者都处于紧急情况下，需要在24小时内进行介入治疗。这意味这些患者进行转诊是可行、可能而且是无害的，比起大规模、经验丰富的医疗中心来说，在小规模、经验不足的医院进行介入治疗的预后更差。

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