Current status and mechanistic insights into nontarget coronary lesions in patients with diabetes and early abnormal glucose metabolism.

The introduction of drug-eluting stents has significantly reduced the incidence of in-stent restenosis. Despite this, recurrent cardiovascular events related to untreated nontarget lesions (NTLs) are becoming more common and accounting for more than 50% of all recurrent cardiovascular events. In patients with diabetes, factors such as prolonged disease duration, poor glycemic control, insulin use, and inadequate lipid management may exacerbate the progression of NTLs and adverse cardiovascular events. Additionally, glycemic fluctuations have been linked to an increased risk of future cardiovascular events in patients with early glucose metabolism abnormalities and acute hyperglycemia. In this review, we explored the clinical and plaque characteristics of patients with diabetes and early glucose metabolism disorders, the percutaneous coronary intervention strategies for NTLs, and their prognostic implications. Furthermore, we investigated the mechanistic links between adverse cardiovascular outcomes and elevated inflammation, oxidative stress, hypercoagulability, and endothelial dysfunction.