Date of Award

January 2020

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Alexandra Lansky

Abstract

The totality of evidence for revascularization decisions between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease comes from predominantly male patients. Although societal guidelines do not provide sex specific recommendations, growing evidence suggests that revascularization outcomes may not be consistent between sexes. This study evaluates outcomes of CABG versus PCI in female patients with multivessel disease (MVD) and/or left main disease (LMD). We conducted a systematic search to identify randomized controlled trials (RCTs) comparing the long-term outcomes after PCI versus CABG in MVD and/or LMD. We extracted female specific data and calculated the primary endpoint of interest: a composite hazard ratio (HR) of all-cause death, myocardial infarction, or stroke. A total of 6 RCTs including 1909 female patients were included in the meta-analysis, with follow up times ranging from 12-60 months. The composite endpoint favored CABG compared with PCI (HR 1.31, 95% CI = 1.05-1.63, p = 0.017). Therefore, females with MVD and/or LMD undergoing revascularization have a 30% lower hazard of long-term ischemic complications with CABG compared to PCI. Current evidence for females remains heterogeneous and inadequate to conclusively align with current guideline recommendations and calls for additional randomized evidence.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/31/2023

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