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Repeat revascularization and death following percutaneous coronary intervention in patients with Type 2 Diabetes: risk factors, biological mechanisms and prognostic models

Mbwana, Mwanatumu Shee (2021) Repeat revascularization and death following percutaneous coronary intervention in patients with Type 2 Diabetes: risk factors, biological mechanisms and prognostic models. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Patients with Type 2 Diabetes (T2D) have higher rates of repeat revascularization following percutaneous coronary intervention (PCI) compared to patients without diabetes. We identified risk factors that are associated with repeat revascularization following PCI in this patient population and developed risk prediction models.
Aim 1 used Cox regression to assess the association of lipid, hemostasis, adipokine, and kidney function biomarkers with target vessel revascularization and any repeat revascularization (ARR), adjusting for non-biomarker risk factors identified in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Non-biomarker risk factors associated with the outcomes included age, prior revascularization, insulin, number of lesions with thrombus, hypercholesterolemia, insulin use and left circumflex artery stenosis. No biomarkers at baseline were associated with the outcomes. Time-varying fibrinopeptide A was associated with an increased risk for ARR.
Aim 2 identified potential biological mechanisms associated with repeat revascularization in the BARI 2D trial by leveraging time-varying survival Classification and Regression Tree (CART) analysis to identify high risk biomarker profiles. Biological mechanisms potentially associated with the outcome included hemostasis, endothelial dysfunction, hyperlipidemia, monocyte recruitment, and increased inflammation relative to baseline.
Aim 3 used University of Pittsburgh Medical Center registry data and CART methodology to identify profiles of patients with T2D associated with repeat revascularization and death following PCI. Risk flow charts with patient risk factor profiles for both repeat revascularization and death were created to aid physicians and patients in clinical settings. The 1-year risk flow chart for repeat revascularization included multivessel disease, age, prior peripheral arterial disease, prior PCI and number of lesions attempted for treatment. The 2-year risk flow chart for death included prior heart failure, age, and pre-procedure creatinine and hemoglobin.
Public health relevance: The rate of repeat revascularization after PCI in patients with T2D is higher than in patients without diabetes and the rate of repeat revascularization after PCI is also higher compared to coronary artery bypass grafting. Nevertheless, the use of PCI in patients with T2D is increasing. Given the rising global incidence of T2D, it is becoming increasingly important to understand factors that lead to repeat revascularization after PCI in this population.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Mbwana, Mwanatumu Sheemsm119@pitt.edumsm119
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorBertolet, Marniebertoletm@edc.pitt.edubertoletm
Committee MemberBrooks, Maria MoriMBROOKS@pitt.eduMBROOKS
Committee MemberCostacou, TinaCostacouT@edc.pitt.eduCostacouT
Committee MemberMulukutla, Suresh Raghumulukutlasr@upmc.edusrm12
Date: 19 January 2021
Date Type: Publication
Defense Date: 24 November 2020
Approval Date: 19 January 2021
Submission Date: 10 December 2020
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 161
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: atherosclerosis, cardiovascular disease, cvd, machine learning, upmc, risk prediction, prognostic, cathpci
Date Deposited: 19 Jan 2021 20:43
Last Modified: 19 Jan 2023 06:15


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