Cardiovascular disease is the leading cause of mortality worldwide, and approximately half of all cardiovascular deaths are attributed specifically to coronary artery disease (CAD). Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) procedures play a prominent role in managing the heavy burden of CAD. The purpose of this dissertation was to evaluate revascularization treatment in patients with multivessel coronary disease. Specifically, predictors of long-term prognosis and factors related to selection of revascularization strategy were investigated in the BARI and BARI 2D cohorts, respectively.
In BARI, treatment with CABG was associated with a significantly lower risk of sudden cardiac death, but did not impact any other causes of mortality. Moreover, protection conferred by CABG was observed in patients regardless of diabetes status.
Following successful initial PCI in BARI, male gender, proximal LAD disease, and incomplete revascularization were associated with an increased risk of a first subsequent revascularization event but not latter events. Diabetes and extensive CAD, on the other hand, demonstrated an incremental impact on the number of repeat procedures over 10 years of follow-up.
Among patients with diabetes and stable CAD in BARI 2D, angiographic features associated with the extent and location of coronary disease greatly influenced the decision to perform CABG over PCI. Geographic region, independent of patient characteristics, was also a driving factor in treatment selection, with a greater propensity to recommend PCI in the US. In all countries of origin, we observed substantial variation across individual clinical sites in this decision-making process.
Results in the BARI cohort may have clinical implications on guiding initial revascularization strategy and underscore the importance of intensive management of atherosclerotic risk factors in order to limit disease progression. Our investigation of BARI 2D demonstrate the need for rigorous evaluation of optimal CAD treatment approaches in diabetic patients and factors that guide this decision-making process in current practice. Overall, these findings may be useful for devising long-term treatment strategies that address the chronic, progressive, and systemic nature of coronary disease, which will be of great public health importance as medical advances continue to extend the lives of individuals with CAD.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-08042006-134555 |
| Date | 09 October 2006 |
| Creators | Kim, Lauren Ji-Yon |
| Contributors | FRANCESMARY MODUGNO, PHD, OSCAR C. MARROQUIN, MD, KEVIN E. KIP, PHD, SHERYL KELSEY, PHD, MARIA MORI BROOKS, PHD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-08042006-134555/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
Page generated in 0.0025 seconds