Do Diabetic Patients with Acute Coronary Syndromes Have a Higher Threshold for Ischemic Pain?

Abstract

Background:Data from over 4 decades have reported a higher incidence of silent infarction among patients with diabetes mellitus (DM), but recent publications have shown conflicting results regarding the correlation between DM and presence of pain in patients with acute coronary syndromes (ACS).Objective:Our primary objective was to analyze the association between DM and precordial pain at hospital arrival. Secondary analyses evaluated the association between hyperglycemia and precordial pain at presentation, and the subgroup of patients presenting within 6 hours of symptom onset.Methods:We analyzed a prospectively designed registry of 3,544 patients with ACS admitted to a Coronary Care Unit of a tertiary hospital. We developed multivariable models to adjust for potential confounders.Results:Patients with precordial pain were less likely to have DM (30.3%) than those without pain (34.0%; unadjusted p = 0.029), but this difference was not significant after multivariable adjustment, for the global population (p = 0.84), and for subset of patients that presented within 6 hours from symptom onset (p = 0.51). In contrast, precordial pain was more likely among patients with hyperglycemia (41.2% vs 37.0% without hyperglycemia, p = 0.035) in the overall population and also among those who presented within 6 hours (41.6% vs. 32.3%, p = 0.001). Adjusted models showed an independent association between hyperglycemia and pain at presentation, especially among patients who presented within 6 hours (OR = 1.41, p = 0.008).Conclusion:In this non-selected ACS population, there was no correlation between DM and hospital presentation without precordial pain. Moreover, hyperglycemia correlated significantly with pain at presentation, especially in the population that arrived within 6 hours from symptom onset.

Warm and Humidified Versus Cold and Dry CO2 Pneumoperitoneum in Minimally Invasive Colon Resection: A Randomized Controlled Trial

“…Diabetics may develop peripheral neuropathy and numbness in the feet or hands and there is evidence suggesting that diabetics have a higher pain threshold during myocardial ischemia due to autonomic neuropathy. 15,16 Decreased postoperative pain following abdominal surgery, however, has not been reported. Regardless, when the 5 DM patients are dropped from the WH group, significant differences in daily narcotic doses were noted solely on POD 1 and no differences in ketorolac daily doses were found.…”

Determining factors in the development of coronary plates and obstructions

“…TCcor as an evaluation, demonstrated that asymptomatic diabetic patients had a high prevalence of coronary obstructions, affecting two or more coronary segments 22 . So also in a study carried out with 3,544 individuals that associated DM2 and precordial pain indicative of myocardial ischemia, found a relationship between hyperglycemia and pain suggestive of CAD 23 .…”

Neuropatia Periférica E Sinais Clínicos De Síndrome Coronariana Aguda Em Pacientes Com Diabetes Mellitus

“…Outro estudo que avaliou uma população de 3.544 diabéticos admitidos em um hospital terceirizado por SCA, não houve correlação entre a ausência da dor e o diabetes, e foi citado que a neuropatia diabética pode interferir na sensação da dor, porém esta alteração na sensibilidade dolorosa só é evidenciada em pacientes com neuropatia avançada (17)(18) , deste modo pode ser esclarecido que a dor precordial foi percebida pelos participantes desta pesquisa ainda que apresentasse algum grau de neuropatia periférica.…”

“…Durante todo o acompanhamento, 5% dos indivíduos com NP apresentaram eventos cardiovasculares em comparação com 2,8% de indivíduos sem NP (13) . Pacientes com doença aterosclerótica portadores de DM têm sido sujeitos de diversas pesquisas com o intuito de avaliar a melhor forma de estratificação de risco, com o objetivo de reduzir as complicações na fase aguda (8)(9)(10)(11)(12)(14)(15)(16)(17)(18) . Diante da dificuldade na triagem nos serviços de emergências em pacientes DM, em decorrência da presença de sinais atípicos secundários à neuropatia periférica, são altamente indicados instrumentos que possam facilitar a identificação destas condições ou mesmo estratificar o risco de mortalidade/ complicações destes pacientes.…”