<International Circulation>: Maybe the SYNTAX score is not ideal enough to identify the best candidates for CABG or PCI because it is based mainly on the angiographic findings of the lesion，and the general condition of patients including co-morbidity is less taken into consideration， do you agree to this viewpiont? If yes what should we do further to improve this stratification tool?

  《国际循环》：SYNTAX评分对确定CABG或PCI的最佳候选者或许不够理想，因为其主要是基于病变的血管造影结果，而较少考虑患者包括合并症在内的一般情况。您赞同这一观点吗？如果赞同，那么我们应怎样改善这一分层工具呢？

    Dr. Eeckhout: I agree. The SYNTAX score is only an angiographic score and doesn’t represent the entire clinical picture of the patient involving co-morbidities. Therefore the surgical assessment tool called the Euro score is also useful and represents surgical risk as score increases. We should use both scores. In multi-vessel patients it is very easy to calculate the Euro score and SYNTAX score and based on both of the a decision should be made. I fully agree that the de-limitation of SYNTAX and the fact that we do not take in to account the co-morbidities is a shortcoming but in that case the Euro score can guide us. A concrete example being a patient with a high SYNTAX score， so the patient would have to go for surgery. If the Euro score is also low than there is only an argument for surgery. If the patient has a very high Euro and SYNTAX scores and because of that the patient would be turned down for surgery because of the co-morbidities， than we find ourselves back at the best decision making position. Patients in the SYNTAX registry were patients with very high Euro scores and high SYNTAX scores such that the surgeon did not want to operate. These patients， despite everything， with having received PCI， faired quite well. Simply using scores and guidelines we can get out of trouble and make decisions.

    Eeckhout博士：我同意这一观点。SYNTAX评分仅仅是血管造影评分，并不代表患者全部的临床表现，包括合并症。因此，被称为EuroSCORE的手术评估工具也是有用的，且随评分升高代表着手术风险。这两种评分我们都应该利用。在多支血管病变患者中，计算EuroSCORE和SYNTAX评分非常容易，基于这两种评分，应当作出决定。我完全同意SYNTAX的界定和我们未考虑合并症的事实是一个缺点，但在这种情况下，EuroSCORE可以指导我们。具体举例如一个SYNTAX评分高的患者，那么患者将会去手术。如果EuroSCORE评分也低，那么就只有手术的理由。如果患者Euro和SYNTAX评分都非常高，且由于该患者因为合并症而不能手术，那么我们发现自己回到了最佳的做出决策的位置。SYNTAX注册研究中的患者是Euro评分非常高且SYNTAX评分高的患者，因此外科医生不想手术。无论如何，这些已经接受PCI的患者做得相当好。简单地利用评分和指南，我们可以摆脱困境，作出决定。