Page 147 - Read Online

Ghunaim et al. Vessel Plus 2023;7:29 Vessel Plus
DOI: 10.20517/2574-1209.2023.112

Review Open Access

Disparities in therapies for coronary artery disease

with reduced left ventricular ejection fraction

1,2
3
1
4
1
Abdullah H. Ghunaim , Dominique Vervoort , Lina A. Elfaki , Mimi X. Deng , Guillaume Marquis-Gravel ,
Stephen E. Fremes 1,2,5
1
Division of Cardiac Surgery, University of Toronto, Toronto, ON M5G 2C4, Canada.
2
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada.
3
Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
4
Montreal Heart Institute, University of Montreal, Montreal, QC H1T 1C8, Canada.
5
Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
Correspondence to: Prof. Stephen E. Fremes, Division of Cardiac Surgery, University of Toronto, Schulich Heart Centre,
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room H4 05, Toronto, ON M4N 3M5, Canada. E-mail:
stephen.fremes@sunnybrook.ca
How to cite this article: Ghunaim AH, Vervoort D, Elfaki LA, Deng MX, Marquis-Gravel G, Fremes SE. Disparities in therapies for
coronary artery disease with reduced left ventricular ejection fraction. Vessel Plus 2023;7:29. https://dx.doi.org/10.20517/2574-
1209.2023.112
Received: 21 Aug 2023 First Decision: 27 Oct 2023 Revised: 11 Nov 2023 Accepted: 23 Nov 2023 Published: 27 Nov 2023
Academic Editors: Jerzy Beltowski, Paolo Nardi Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is
used to manage left ventricular systolic dysfunction (LVSD) due to coronary artery disease (CAD). This review
provides an overview of coronary revascularization for CAD with reduced left ventricular ejection fraction (LVEF),
focusing on disparities in management. CABG provides more complete revascularization, and lower long-term all-
cause mortality and reintervention and MI rates compared to PCI in patients with LVSD and CAD. Consequently,
CABG is recommended as the primary revascularization therapy for CAD with reduced LVEF, with PCI being
reserved for patients who are high-risk or have unfavorable coronary anatomy. Although LVSD increases
revascularization risk, differential outcomes can be attributed to patients’ biological, behavioral, and socioeconomic
factors as well as health system deficiencies. Women and racially and/or ethnically minoritized patients often
present with progressive disease and greater comorbidity, experience delays in diagnosis and treatment, and have
higher morbidity and mortality rates post-revascularization. These disparities may be explained by biological
differences compounded by social determinants of health. Patients with CAD with LVSD pose unique medical
challenges, which may be further complicated by disparities in care. Increased representation of minoritized
patients in cardiovascular trials is needed to elucidate these differences and their long-term impact.
Keywords: Coronary artery disease, left ventricular systolic dysfunction, heart failure, coronary artery bypass
grafting, percutaneous coronary intervention, disparities

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.oaepublish.com/vp