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Acute Coronary Syndrome in Patients with Diabetes mellitus: Features of the Course and Manifestations of Pain Syndrome

Acute coronary syndrome (ACS) remains a common cause of hospitalization for patients with diabetes mellitus (DM). Due to development of diabetic neuropathy, it is believed that this category of patients is characterized by a high frequency of atypical acute coronary syndrome, but data on this are quite contradictory.
The objective: to determine the features of the pain syndrome and its severity in patients with acute coronary syndrome and concomitant diabetes.
Materials and methods. The study involved 36 patients with diabetes (22 men and 14 women) aged 44–86 years, hospitalized urgently for ACS. Pain syndrome was assessed at the time of hospitalization and immediately after coronary artery revascularization according to the following criteria: visual analog scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers.
Results. The majority of patients (91.67%) at the time of hospitalization complained of chest pain, the rest were not bothered by any pain. During the survey, patients described pain as «burning» (30.56%), «squeezing» (30.56%), «squeezing» (25.0%), «tingling» (5.56%). There were also complaints of difficulty breathing (13.89%), shortness of breath (11.1%), palpitations (41.67%). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of pain assessment by VAS and NRS (p>0.1). The average value of glycemia at the time of hospitalization was 8.19±3.45 mmol/l (men – 8.17±3.61 mmol/l, women – 8.28±3.13 mmol/l). Glycemia greater than 10.0 mmol/l was detected in 8 patients, which was 22.22% of all patients. This category of patients was dominated by patients with severe pain (62.5%).
Conclusions. In patients with ACS and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Prior to revascularization, moderate and severe pain occurred with equal frequency; there is no statistical difference between blood pressure, heart rate and glycemia (p>0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was found in 22.22%, among this category of patients was dominated by patients with severe pain.