Page 157 - Read Online

Ghunaim et al. Vessel Plus 2023;7:29 https://dx.doi.org/10.20517/2574-1209.2023.112 Page 11 of 17

[131]
trials to submit results of sex/gender, race, and/or ethnicity analysis to Clinicaltrials.gov . To optimize
treatment for our diverse patient populations, further research, increased inclusion, improved patient
engagement, and more honest reflection are necessary.

Furthermore, patients’ broader social determinants of health must be properly recognized to ensure
adherence to OMT, long-term follow-up, and lifestyle changes, each of which has been negatively associated
with low socioeconomic status, low health literacy, and other determinants after both PCI and CABG [132,133] .
In addition, biases in care must be evaluated and addressed, as women and patients of low socioeconomic
status observe lower rates of multiple arterial grafting [132-134] . Unconscious bias training may reduce
differential practices between patient populations that are not fully guided by clinical indications .
[135]
Simultaneously, engaging patients and communities through community-based participatory research and
patient-centered outcomes can strengthen the physician-patient relationship, highlight gaps in care that
may be bridged, and promote shared decision-making [136,137] . These efforts should be rooted in the context
and culture of the local community as patient preferences and community values may vary considerably by
country and population.

CONCLUSION
CAD with LVSD poses unique challenges. Current guidelines are based on limited randomized and
observational evidence for LVSD, requiring direct trial evidence comparing CABG and PCI in patients with
LVSD. Ongoing trials, such as the STICH3C trial (NCT05427370) and the broader STICH3.0 International
Consortium, will shed further light on the management of this complex patient population. In addition,
further work is needed to elucidate and address disparities in access to and outcomes after coronary
revascularization, which will require the engagement of multidisciplinary Heart Teams, primary care
physicians, researchers, and patients.

DECLARATIONS
Authors’ contributions
Writing the manuscript; performed the literature search and review; made substantial contributions to the
conception, design, and edition of the manuscript: Ghunaim AH, Vervoott D, Elfaki LA, Deng MX,
Marquis-Gravel G, Fremes SE
Prepared the figures and tables: Ghunaim AH, Vervoott D, Elfaki LA, Deng MX

Availability of data and materials
Not applicable.

Financial support and sponsorship
This manuscript is supported in part by the Canadian Institutes of Health Research (CIHR) grant #471008.
DV is supported by the CIHR Vanier Canada Graduate Scholarship for work outside this manuscript.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.