Has anything changed in multivessel coronary artery revascularization in diabetes since BARI?
Diabetic patients have an increased risk of coronary disease partly due to a higher frequency of associated risk factors including hypertension and hyperlipidemia but also from specific risks largely resulting from insulin resistance, hyperinsulinemia and hyperglycemia. This has resulted in a greater need for revascularization. Despite this there are few randomized data comparing surgery and angioplasty in patients with diabetes. The evidence to define the best operative strategy is limited, mainly confined to a subanalysis of the BARI trial suggesting the superiority of surgery in patients with multivessel disease. However there has been in Europe a wide increase in multivessel angioplasty, even in diabetic patients. This article discusses the higher risk of patients with diabetes, the data comparing surgery and angioplasty and outlines the advances in angioplasty since BARI.
Kapur
Akhil
A
Department of Cardiology, Hammersmith Hospital, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.
Bartolini
Davide
D
Beatt
Kevin J
KJ
D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology* / Q000601:surgery*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use; D012307:Risk Factors
D019039:Platelet Glycoprotein GPIIb-IIIa Complex