《国际循环》：如果一位心衰患者合并缺血性心脏病，但是没有心绞痛典型表现的话，除了治疗心衰以外，是否还应当实施血运重建？

    <International Circulation>: If we have a heart failure patient who also has ischemic heart disease without the apparent symptom of angina， is there a need for revascularization in addition to heart failure treatment?

    Yancy博士：对于合并缺血性心脏病但是没有心绞痛表现的心衰患者来讲，需要重点指出的是，迄今为止还没有证据显示应当对这些患者积极进行血运重建治疗。出于直觉，我们可能会想射血分数低、合并冠心病的心衰患者需要血运重建治疗。但是，目前还没有相应证据支持此种做法。我想，最终我们可能会证实，给予治疗缺血性心脏病的药物（ACEI，尤其是β受体阻滞剂）并且植入ICD可能有好处。STITCH试验将有助于我们从一个新的角度来了解这一问题，我们将会看到血运重建与药物治疗联合器械治疗相比疗效如何。STITCH试验的主要结果可能在今年晚些时候公布。这将是一个重大时刻，因为STITCH试验的结果可能会改变临床实践。

    Dr. Yancy: The important statement to make about the patient with known ischemic heart disease in the absence of angina， who also has heart failure， is that to date there are no indications to aggressively revascularize those patients. Intuitively we might think that in reduced ejection fraction， coronary heart disease， and heart failure， we should revascularize those patients but we have no evidence that it is appropriate. The evidence may ultimately demonstrate that an evidence-based medical regimen of ACEI and especially beta blockers， because of the ischemia， plus an ICD might be as good. The STITCH trial， which will probably generate primary results later this calendar year， may be able to inform in ways that we have never been able to understand before and it will be a moment of consequence when we see the data for surgical revascularization in that setting versus medical therapy with some influence of device therapy. It will be a very critical moment for us to see that data because those data will represent a change in how we practice.

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