The epidemiology of high-risk coronary artery disease and the choice between stents and surgery

Persistent Link:
http://hdl.handle.net/10150/280632
Title:
The epidemiology of high-risk coronary artery disease and the choice between stents and surgery
Author:
Morrison, Douglass A.
Issue Date:
2004
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
For coronary artery disease (CAD) patients, who cannot be managed with risk factor modification and pharmacologic medical therapy, coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI), are the primary means of treatment. CABG has been considered the standard for patients who are 'high-risk,' because of anatomic or functional characteristics, but stents and modern pharmacologic adjuncts have made PCI much more competitive. Additionally, as the population ages and becomes more comorbid, some of the features of CABG that allowed 'control' of functionally high-risk patients (such as general anesthesia and heart lung bypass) become disadvantages, especially for hemodynamically unstable patients. This dissertation summarizes the only prospective, multicenter, randomized clinical trial (RCT), and prospective registry of CABG versus PCI, specific to high-risk patients: AWESOME. Previously unpublished 5-year survival data is analyzed in the context of the published AWESOME randomized trial, registry and pre-specified subset 3-year results. Qualitative summaries of all published RCTs comparing medical therapy with CABG or PCI and comparing PCI (with or without stents) with CABG are included (Appendix B). Taken together, these data allow the conclusion that PCI is not simply an alternative for high-risk patients, but that for specific patient groups, such as ST-elevation myocardial infarction (STEMI), hemodynamically compromised unstable angina/non-STEMI, and patients with major comorbidity, PCI is the preferred initial revascularization strategy in 2004.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Health Sciences, Medicine and Surgery.; Health Sciences, Public Health.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Epidemiology
Degree Grantor:
University of Arizona
Advisor:
Lebowitz, Michael

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleThe epidemiology of high-risk coronary artery disease and the choice between stents and surgeryen_US
dc.creatorMorrison, Douglass A.en_US
dc.contributor.authorMorrison, Douglass A.en_US
dc.date.issued2004en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractFor coronary artery disease (CAD) patients, who cannot be managed with risk factor modification and pharmacologic medical therapy, coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI), are the primary means of treatment. CABG has been considered the standard for patients who are 'high-risk,' because of anatomic or functional characteristics, but stents and modern pharmacologic adjuncts have made PCI much more competitive. Additionally, as the population ages and becomes more comorbid, some of the features of CABG that allowed 'control' of functionally high-risk patients (such as general anesthesia and heart lung bypass) become disadvantages, especially for hemodynamically unstable patients. This dissertation summarizes the only prospective, multicenter, randomized clinical trial (RCT), and prospective registry of CABG versus PCI, specific to high-risk patients: AWESOME. Previously unpublished 5-year survival data is analyzed in the context of the published AWESOME randomized trial, registry and pre-specified subset 3-year results. Qualitative summaries of all published RCTs comparing medical therapy with CABG or PCI and comparing PCI (with or without stents) with CABG are included (Appendix B). Taken together, these data allow the conclusion that PCI is not simply an alternative for high-risk patients, but that for specific patient groups, such as ST-elevation myocardial infarction (STEMI), hemodynamically compromised unstable angina/non-STEMI, and patients with major comorbidity, PCI is the preferred initial revascularization strategy in 2004.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectHealth Sciences, Medicine and Surgery.en_US
dc.subjectHealth Sciences, Public Health.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineEpidemiologyen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorLebowitz, Michaelen_US
dc.identifier.proquest3145105en_US
dc.identifier.bibrecord.b47210023en_US
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