Diabetics’ Silent Ischemia Myth Busted

Diabetes mellitus patients generally present more diffuse coronary disease, faster lesion progression and higher risk of restenosis after PCI.

The way these anatomical differences translate into in a different clinical practice, compared to non-diabetic patients, remains unclear.

Prior studies comparing the frequency of angina symptoms in diabetic vs. non-diabetic patients have arrived to contradicting outcomes, and historically we have been taught diabetic patients more often present silent ischemia because of autonomic neuropathy. Contrary to these conservative ideas, recent studies suggest diabetic patients have more angina.

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1080 patients undergoing elective coronary angioplasty were analyzed; 34% had a history of diabetes. Angina was assessed with the Seattle Angina Questionnaire before and 1,6 and 12 months after procedure (0 to 100, the higher the value, the better the functional class). Researchers also considered anti-angina medication values at discharge.

Both at baseline and throughout follow up, diabetic patients showed similar angina prevalence and severity to that of non-diabetic patients.

Diabetic patients more often received calcium blockers and prolonged action nitrates whereas B blockers and ranolazine were indicated in similar proportion.

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In multivariable analyzis, the risk of presenting angina at one year after elective coronary PCI was similar between diabetic and non-diabetic patients. (RR 1.04; CI 0.80–1.36).

Conclusion

Diabetic patients with stable heart disease have symptoms as often as non-diabetic patients, even though they do not receive more anti-angina medication. These findings contradict the classical idea about the higher prevalence of silent ischemia amongst diabetics.

Original Title: Residual Angina After Elective Percutaneous Coronary Intervention in Patients with Diabetes Mellitus.

Reference: Anna Grodzinsky et al. Circ Cardiovasc Qual Outcomes. 2017;10:e003553.

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