Related Experiment Video

Updated: Aug 24, 2026

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits
07:34

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits

Published on: June 2, 2019

Has anything changed in multivessel coronary artery revascularization in diabetes since BARI?

Akhil Kapur1, Davide Bartolini, Kevin J Beatt

  • 1Department of Cardiology, Hammersmith Hospital, National Heart and Lung Institute, Imperial College School of Medicine, London, UK.

Italian Heart Journal : Official Journal of the Italian Federation of Cardiology
|June 10, 2004
PubMed

Insights

Diabetic patients face higher coronary disease risks, necessitating revascularization. Limited data compares surgery and angioplasty, though surgery may be superior for multivessel disease.

Area of Science:

  • Cardiology
  • Diabetology
  • Vascular Surgery

Background:

  • Diabetic patients exhibit increased coronary heart disease (CHD) risk due to hypertension, hyperlipidemia, insulin resistance, hyperinsulinemia, and hyperglycemia.
  • These factors elevate the need for coronary revascularization procedures in diabetic individuals.
  • Current evidence comparing surgical revascularization and angioplasty in diabetic patients is limited.

Purpose of the Study:

  • To discuss the elevated risks associated with coronary disease in diabetic patients.
  • To review existing randomized data comparing coronary artery bypass grafting (CABG) surgery and angioplasty in this population.
  • To outline recent advancements in angioplasty techniques since the Bypass Angioplasty Revascularization Investigation (BARI) trial.

Main Methods:

  • Review of existing literature and clinical trial data, focusing on diabetic patients undergoing revascularization.
  • Analysis of sub-studies, particularly the BARI trial, comparing surgical and percutaneous coronary intervention (PCI) outcomes.
  • Discussion of contemporary angioplasty developments and their implications for diabetic patients.

Main Results:

  • Diabetic patients present with a higher frequency of CHD risk factors and specific metabolic derangements.
  • The BARI trial sub-analysis suggested surgical revascularization may be superior for diabetic patients with multivessel coronary artery disease.
  • Despite BARI findings, multivessel angioplasty has seen increased use in diabetic patients in Europe.

Conclusions:

  • Diabetic patients represent a high-risk population for coronary disease requiring careful consideration of revascularization strategies.
  • While surgery showed potential superiority in older trials for multivessel disease, advances in angioplasty warrant ongoing evaluation.
  • Further research is needed to define optimal revascularization strategies for diabetic patients in the current therapeutic landscape.

Related Concept Videos

Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Diabetic Retinopathy01:27

Diabetic Retinopathy

DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...
Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
Complications of Diabetes Mellitus01:22

Complications of Diabetes Mellitus

Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia due to insulin deficiency, resistance, or both. Prolonged hyperglycemia disrupts metabolic homeostasis and leads to acute and chronic complications.Acute ComplicationsAcute complications result from sudden metabolic imbalance.Diabetic ketoacidosis (DKA) mainly appears in type 1 diabetes but may also develop in type 2 diabetes, particularly under extreme stress. It arises from severe insulin deficiency,...
Diabetic Nephropathy01:28

Diabetic Nephropathy

Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration occur due to afferent arteriolar...