City Research Online

Improving outcomes of coronary revascularization in diabetic patients: can real-world data provide strategic decision support?

Raza, S. (2019). Improving outcomes of coronary revascularization in diabetic patients: can real-world data provide strategic decision support?. (Unpublished Doctoral thesis, City, University of London)

Abstract

Coronary artery disease (CAD) is the most common cause of death worldwide making it one of the most important public health issues. For the surgical treatment of CAD, a number of patients, 400,000 in US alone, undergo coronary artery bypass grafting (CABG) each year, making it one of the most widely performed surgeries in the world. During my research fellowship at the Cleveland Clinic, I undertook a series of studies that sought to identify strategies and techniques that improve the short and long-term outcomes of this important procedure. Most of my work was focused towards studying the outcomes of CABG in diabetic patients because patients with diabetes represent an important and growing population of patients undergoing CABG. Through my research work I showed that 1) the patients most likely to benefit from CABG, compared to PCI, are the ones with extensive CAD & comorbidities (like diabetic patients), 2) the proportion of patients undergoing CABG who have diabetes has increased over the last four decades and diabetes is an independent risk factor for worse long-term survival after CABG (20 year survival after CABG: 18% in diabetic patients vs. 42% in non diabetic patients), 3) diabetes does not influence the long term patency of coronary artery bypass grafts and, therefore, worse longterm survival after CABG in diabetic patients is likely not related to worse graft durability, 4) surgical revascularization techniques like bilateral internal thoracic artery (ITA) grafting compared to single ITA grafting and complete revascularization compared to incomplete revascularization are associated with better long-term survival in patients with diabetes undergoing CABG, and 5) bilateral ITA grafting and single ITA plus radial artery grafting are equally effective in terms of hospital outcomes and long term survival for diabetic patients undergoing CABG. Through my research, I also demonstrated how realworld data could be used to provide insights into appropriate strategies for improving the outcomes of different health services and medical procedures.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RZ Other systems of medicine
Departments: Doctoral Theses
Doctoral Theses > School of Health Sciences Doctoral Theses
School of Health Sciences > Healthcare Services Research & Management
Date Deposited: 14 Dec 2020 14:34
URI: https://openaccess.city.ac.uk/id/eprint/25390
[img]
Preview
Text - Accepted Version
Download (90MB) | Preview

Export

Downloads

Downloads per month over past year

View more statistics

Actions (login required)

Admin Login Admin Login