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Comparison of the hospital arrival time and differences in pain quality between diabetic and non-diabetic STEMI
Marina Gradišer1, Dario Dilber2, Jasna Cmrečnjak3
1Department of Endocrinology and Diabetes, County Hospital Čakovec, 40000 Čakovec, Croatia. gradiser007@yahoo.com.
Insights
Diabetic patients with ST-segment elevation myocardial infarction (STEMI) do not arrive later but report less chest pain and more shortness of breath. Early diagnosis and intervention are crucial for improved survival in these patients.
Area of Science:
- Cardiology
- Diabetology
- Emergency Medicine
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular disease, including ST-segment elevation myocardial infarction (STEMI).
- Understanding symptom presentation and outcomes in diabetic STEMI patients is crucial for timely and effective treatment.
Purpose of the Study:
- To compare emergency room arrival times between diabetic and non-diabetic STEMI patients.
- To analyze differences in pain perception and quality in diabetic versus non-diabetic STEMI patients.
- To evaluate in-hospital outcomes for diabetic and non-diabetic STEMI patients.
Main Methods:
- A cohort study including 266 first-time STEMI patients (62 diabetic, 204 non-diabetic) over two years.
- Pain assessment using the McGill short-form questionnaire.
- Comparison of demographic data, symptom presentation, and in-hospital outcomes.
Main Results:
- No significant difference in emergency room arrival times between diabetic and non-diabetic STEMI patients.
- Diabetic patients reported less intense pain (slight/none) compared to non-diabetic patients (moderate/severe).
- Diabetic patients more frequently presented with shortness of breath and were more likely to have multi-vessel disease.
Conclusions:
- Diabetic STEMI patients may present with atypical symptoms like shortness of breath, necessitating cautious evaluation.
- Targeted patient education and organized care, such as primary PCI networks, can improve survival rates in diabetic STEMI patients.
Abstract:
The aim of our study was to determine whether diabetic ST segment elevation myocardial infarction (STEMI) patients arrive in the emergency room (ER) later than non-diabetics, compare the differences in pain quality and quantity between those groups, and measure differences in the outcome after an index hospitalization. A total of 266 patients with first presentation of STEMI were included in our study during a period of two years, 62 with diabetes and 204 without diabetes type 2. Pain intensity and quality at admission were measured using a McGill short form questionnaire. Diabetic patients did not arrive significantly later than non-diabetic (χ²; p = 0.105). Most diabetic patients described their pain as "slight" or "none" (χ²; p < 0.01), while most non-diabetic patients graded their pain as "moderate" or "severe" (χ²; p < 0.01). The quality of pain tended to be more distinct in non-diabetic patients, while diabetic patients reported mainly shortness of breath (χ²; p < 0.01). Diabetic patients were more likely to suffer a multi-vessel disease (χ²; p < 0.01), especially in the late arrival group. Therefore, cautious evaluation of diabetic patients and adequate education of target population could improve overall survival while well-organized care like a primary PCI Network program could significantly reduce CV mortality.
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