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Background: Impaired glucose tolerance (IGT) patients are known to have a higher risk of cardiovascular events and their prognosis is reported to be poor. We, therefore, aimed to compare the complexity and vulnerability of coronary artery disease (CAD) among normal glucose tolerance (NGT), IGT and diabetes mellitus (DM). Methods: 232 patients (66.4 ± 12.6 years, 201 male) who received percutaneous coronary intervention for coronary artery disease were enrolled in the present study. All of the patients except those already given the diagnosis of DM underwent 75g oral glucose tolerance test (OGTT). The study cohorts were divided into 3 groups; DM (n=118), IGT (n=67), and NGT (n=47). IGT was defined as 2 hour post-load plasma glucose ≥140mg/dl during the OGTT. The lesion complexity was expressed as SYNTAX score. The vulnerability of coronary plaque was determined by optical coherence tomography (OCT). Results: Glycated hemoglobin (HbA1c) level was significantly higher in DM group (6.7±1.3%) than IGT (5.8±0.3%, P Conclusions: The lesion complexity and plaque vulnerability of IGT patients are not inferior to those of DM patients and significantly greater than NTG patients.