Impact of glycemic status on coronary lesion characteristics in patients with symptomatic coronary artery disease

Purpose This study aims to determine if higher blood sugar, even within the prediabetes range, affects coronary lesion characteristics. Material and methods Symptomatic patients with confirmed CAD on CCTA were stratified into three different groups based on their glycated-hemoglobin (HbA1c) levels: 1) Euglycemia, HbA1c below 5.7% (HbA1c < 39 mmol/mol) 2) Prediabetes, HbA1c-levels between 5.7% and 6.4% (HbA1c = 39-46 mmol/mol) 3) Diabetes, HbA1c-levels ≥6.5% (HbA1c ≥ 48 mmol/mol). A plaque analysis of culprit lesions on CCTA using a dedicated plaque analysis software was performed and findings between the three different groups were compared. Results Overall 184 patients and 247 coronary lesions were analyzed. Coronary lesion length was significantly greater in prediabetic [(29.5 mm (12.7–50-4) versus 24.8 mm (11.4–51.1), p = 0.025)] and diabetic individuals [(30.1 mm (16.7–50.2) versus 24.8 mm (11.4–51.1), p = 0.005)] compared to those with normal HbA1c levels. In terms of plaque composition and volume, diabetic individuals demonstrated a significantly higher amount of total lipid-rich plaque volume [(62.5 mm 3 (38.1–93.7) versus 41.9 mm 3 (22.4–66.7), p < 0.001] and total fibrotic plaque volume [55.7 mm 3 (37.1–92.2) versus 29.3 mm 3 (16.9–61.2), p = 0.004] compared to euglycemic patients. In multivariable adjusted logistic regression, there was a significant association between both prediabetes and diabetes and predominantly non-calcified plaques (odds ratio [OR] 2.124 [95% CI (1.016–4.437), p = 0.045 and OR 2.505 (1.029–6.098), p = 0.043]. Conclusion Poor glycemic status is associated with a higher prevalence of predominantly noncalcified plaques in symptomatic individuals. When compared to euglycemic individuals, prediabetic individuals demonstrate an extended coronary lesion length similar to diabetics. These factors may play a role in the poorer clinical outcomes even observed in patients with borderline diabetes.