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EVALUATION OF TREATMENTS FOR CORONARY ARTERY DISEASE UTILIZING CONTEMPORARY STATISTICAL METHODS

Kim, Lauren Ji-Yon (2006) EVALUATION OF TREATMENTS FOR CORONARY ARTERY DISEASE UTILIZING CONTEMPORARY STATISTICAL METHODS. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

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.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kim, Lauren Ji-YonKimL@edc.pitt.edu
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBROOKS, MARIA MORIbrooks@edc.pitt.eduMBROOKS
Committee MemberMODUGNO, FRANCESMARYfmm@cs.cmu.edu
Committee MemberKIP, KEVIN Ekipk@edc.pitt.edu
Committee MemberMARROQUIN, OSCAR Cmarroquinoc@upmc.eduOSM3
Committee MemberKELSEY, SHERYLkelsey@edc.pitt.eduKELSEYS
Date: 9 October 2006
Date Type: Completion
Defense Date: 23 August 2006
Approval Date: 9 October 2006
Submission Date: 4 August 2006
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: coronary artery disease; coronary revascularization; diabetes mellitus; mortality
Other ID: http://etd.library.pitt.edu/ETD/available/etd-08042006-134555/, etd-08042006-134555
Date Deposited: 10 Nov 2011 19:56
Last Modified: 19 Dec 2016 14:37
URI: http://d-scholarship.pitt.edu/id/eprint/8879

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