Inflammation is increasingly recognized as an important contributor to adverse cardiovascular outcomes in patients with diabetes and coronary artery disease (CAD). In an observational analysis from the INFLAMED study presented at the EuroPCR 2026, investigators evaluated associations between inflammatory biomarkers and CAD extent among patients presenting with acute coronary syndrome (ACS), with a focus on type 2 diabetes (T2D) and pre-diabetes.

High-sensitivity C-reactive protein (hsCRP) was measured clinically at admission, while plasma samples collected during follow-up were analyzed for hsCRP, interleukin-6 (IL-6), and interleukin-18 (IL-18). 

Findings

• The study enrolled 116 patients admitted with ACS to Oxford University Hospital.
• SYNTAX scores were similar between patients with and without diabetes or pre-diabetes (24 ± 11.9 vs 22 ± 11.9; p=0.513).
• At admission, hsCRP levels were numerically higher in patients with diabetes or pre-diabetes compared with those without dysglycemia [3.9 (1.4-8.0) vs 2.35 (1.1-4.4) mg/L; p=0.09].
• Patients with high SYNTAX scores had significantly higher hsCRP concentrations at admission [3.9 (1.6-8.7) vs 1.9 (1.0-4.5) mg/L; p=0.01].
• The association between higher hsCRP and extensive CAD appeared more pronounced among patients with diabetes [5.1 (2.6-11.0) vs 2.5 (1.6-5.8) mg/L; p=0.052].
• In multivariable analysis adjusted for age, sex, and BMI, both high SYNTAX score (β=0.32; p=0.002) and diabetes status (β=0.25; p=0.01) were independently associated with higher hsCRP levels.
• At follow-up, hsCRP concentrations were similar between patients with and without diabetes or pre-diabetes (p=0.223).
• IL-6 [4.64 (2.8-6.35) vs 3.38 (2.03-4.76) pg/mL; p=0.051] and IL-18 [340 (266-422) vs 274 (224-369) pg/mL; p=0.032] remained higher in patients with diabetes or pre-diabetes during follow-up.
• After multivariable adjustment, diabetes status remained independently associated only with IL-18 levels (β=0.08; p=0.044).

The findings suggest that acute inflammatory activation, reflected by hsCRP levels at presentation, is associated with more extensive coronary artery disease in patients with ACS, particularly among those with diabetes or pre-diabetes. In contrast, inflammatory markers measured during follow-up showed weaker associations with CAD extent.