Patients with type 2 diabetes mellitus (T2DM) often present with more complex coronary artery disease (CAD) after acute coronary syndrome (ACS), but the relationship between inflammation and CAD extent remains incompletely understood. A study presented at EuroPCR 2026 evaluated the association between inflammatory markers and CAD burden in patients presenting with ACS.
The INFLAMED study included 116 patients admitted to Oxford University Hospital with ACS. The cohort had a mean age of 66 years, and 53.4% had T2DM or pre-diabetes. Coronary disease severity was stratified using the SYNTAX score. Clinical high-sensitivity C-reactive protein (hsCRP) measurements were obtained at a median of 0 days from admission in 99 patients. Follow-up plasma samples were collected at a median of 57 days after discharge in 86 patients to measure hsCRP, interleukin-6 (IL-6), and interleukin-18 (IL-18).
Findings
- SYNTAX scores were similar between patients with and without T2DM or pre-diabetes (mean 24 ± 11.9 vs 22 ± 11.9; p = 0.513).
- Admission hsCRP levels were significantly higher in patients with high SYNTAX scores than in those with low SYNTAX scores (3.9 [1.6-8.7] vs 1.9 [1.0-4.5] mg/L; p = 0.01). The association was more pronounced in patients with T2D or pre-diabetes (5.1 [2.6-11.0] vs 2.5 [1.6-5.8] mg/L; p = 0.052).
- After adjustment for age, sex, and body mass index (BMI), both high SYNTAX score (β = 0.32; p = 0.002) and diabetes status (β = 0.25; p = 0.01) remained independently associated with higher admission hsCRP levels.
- Follow-up hsCRP levels were similar between groups (median 1.5 [0.9-3.6] vs 1.2 [0.5-5.0] mg/L; p = 0.223).
- IL-6 levels showed a trend toward higher values in patients with T2DM or pre-diabetes, while IL-18 levels were significantly higher in this group (340 [266-422] vs 274 [224-369] pg/mL; p = 0.032).
- After adjustment for age, sex, BMI, and CABG status, high SYNTAX score was not associated with hsCRP, IL-6, or IL-18 at follow-up, while diabetes status remained independently associated with IL-18 only (β = 0.08; p = 0.044).
The findings suggest that hsCRP measured during acute ACS may better reflect inflammatory activity associated with extensive CAD than measurements obtained during follow-up.
