Susceptibility to Pain During Coronary Angioplasty: Usefulness of Pulpal Test

Objectives. This study in patients with coronary artery disease (CAD) sought to 1) determine the dental pain threshold and reaction to tooth pulp stimulation; 2) correlate the clinical, ergometric and angiographic features of patients with and without pain during percutaneous transluminal coronary angioplasty (PTCA) to pulpal test response; 3) verify whether reactivity to dental pulp stimulation could help to identify patients particularly prone to perceiving angin during myocardial ischemia. Background. Silent myocardial ischemi is frequently observed in patients with CAD. Higher pain thresholds have been documented in asymptomatic subjects, suggesting generalized hyposensitivity to pain. Methods. Eighty-six consecutive male patients with reproducible exercise-induced myocardial ischemi and CAD documented by angiography underwent PTCA. pulpal test was performed in all patients by means of an electrical tooth pulp stimulator. Results. Seventy-one patients (82.6%) with and 15 (17.4%) without angin during daily life were studied. During the pulpal test, 57 patients (66.2%) reported dental pain, whereas 29 (33.7%) were asymptomatic, even at maximal stimulation of 500 mA. The study cohort was classified into two groups according to the presence (58 patients [group 1]) or absence (28 patients [group 2]) of angin during myocardial ischemi induced by PTCA. Ergometric variables, extent of CAD, presence of ST segment elevation during PTCA, number of inflations, inflation time and maximal inflation pressure were similar in the two patient groups. Dental pain was provoked by pulpal test in 81% of patients with and 36% of patients without symptoms during PTC (p = 0.0004). The absence of dental pain even at maximal tooth pulp stimulation (500 mA) was observed in 11 (18.9%) patients in group 1 and 18 (64.2%) in group 2. Patients who were asymptomatic during PTC had higher mean dental pain threshold, lower mean threshold reaction and lower mean maximal reaction than those who were symptomatic during both PTC and the pulpal test. Conclusions. correlation between the prevalence of symptoms during pulpal test, daily life, exercise-induced myocardial ischemi and PTC was found. higher dental pain threshold and lower reactivity characterized those subjects who were prone to silent ischemi both during daily life and during PTCA. Ergometric variables, extent of CAD and techniques used during PTC were unrelated to the tendency to perceive pain during myocardial ischemia. Response to the pulpal test and the presence of symptoms during daily life were highly related to the presence of angin during PTCA.