Prediabetes in Acute Coronary Syndrome: An Overlooked Predictor of Adverse Outcomes

Prediabetes in Acute Coronary Syndrome: An Overlooked Predictor of Adverse Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prediabetes in Acute Coronary Syndrome: An Overlooked Predictor of Adverse Outcomes Daniel Hakim, Louay Taha, Mohammad Karmi, Eyal Ben-Zvi, Asher Schnur, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7526459/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Hemoglobin A1c (HbA1c) is a well-established marker for long-term glycemic control and a diagnostic tool for diabetes mellitus (DM). The relationship between HbA1c levels and prognosis among acute coronary syndrome (ACS) patients is not well described. The aim of the current study was to evaluate the prognostic value of admission HbA1c levels in patients with ACS admitted to contemporary intensive cardiovascular care unit (ICCU). Methods A prospective single center study included all patients admitted to the ICCU between July 2019 and December 2024 with ACS. Patients were categorized by HbA1c levels into three groups: non-DM (< 5.7%), pre-DM (5.7–6.4%), and DM (≥ 6.5%). Demographics, clinical characteristics, in-hospital complications, and long-term (up to 60 months) mortality were analyzed. Results A total of 2,772 patients were admitted with a diagnosis of ACS and had HbA1c levels recorded at admission. Among them, 41.4% were non-diabetic, 29.1% had pre-diabetes, and 29.5% had diabetes. In-hospital mortality showed a gradual increase across these groups: 2.0% in non-diabetics, 1.6% in pre-diabetics, and 2.9% in diabetics (p = 0.294). Long-term mortality rose significantly with higher HbA1c categories, reaching 11.4%, 14.7%, and 18.1%, respectively (p < 0.001). Multivariate analysis confirmed DM as an independent predictor of mortality (HR 1.635, 95% CI: 1.280–2.08, p < 0.001). Conclusions Over half of patients admitted with an ACS have evidence of dysglycemia. Both pre-DM and DM groups were associated with increased long-term mortality in ACS patients. The findings highlight the need for greater recognition and management, especially of pre-DM ACS patients in acute cardiovascular care. Full Text Additional Declarations No competing interests reported. Supplementary Files DanielH.data25.8.sav Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7526459","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513745619,"identity":"d8784ce3-c4e7-4e10-9386-bc2f860020d4","order_by":0,"name":"Daniel Hakim","email":"data:image/png;base64,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","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Hakim","suffix":""},{"id":513745620,"identity":"a16d2030-24c7-4cfe-9624-02ec5bb576a2","order_by":1,"name":"Louay Taha","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Louay","middleName":"","lastName":"Taha","suffix":""},{"id":513745621,"identity":"66dbf407-86da-4cfd-8822-a2ba934f2a5e","order_by":2,"name":"Mohammad Karmi","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Karmi","suffix":""},{"id":513745622,"identity":"add37f87-aab4-4493-8c38-9b30189f6bd7","order_by":3,"name":"Eyal Ben-Zvi","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Eyal","middleName":"","lastName":"Ben-Zvi","suffix":""},{"id":513745623,"identity":"49c27188-9952-42b3-b230-9278704de7c2","order_by":4,"name":"Asher Schnur","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Asher","middleName":"","lastName":"Schnur","suffix":""},{"id":513745624,"identity":"b051879f-42f7-439c-84ea-40290abdf0ec","order_by":5,"name":"Rafael Hitter","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Rafael","middleName":"","lastName":"Hitter","suffix":""},{"id":513745625,"identity":"7797804e-de25-4cfb-a887-10b50b9c0097","order_by":6,"name":"Noam Fink","email":"","orcid":"","institution":"Assuta Medical Centers","correspondingAuthor":false,"prefix":"","firstName":"Noam","middleName":"","lastName":"Fink","suffix":""},{"id":513745626,"identity":"c1e2b1f6-89ee-4856-86de-a38b76eee5e5","order_by":7,"name":"Pierre Sabouret","email":"","orcid":"","institution":"Hôpital Pitié-Salpêtrière, Sorbonne Université","correspondingAuthor":false,"prefix":"","firstName":"Pierre","middleName":"","lastName":"Sabouret","suffix":""},{"id":513745627,"identity":"8e0308ff-ec33-4bcf-b024-d99443428dfa","order_by":8,"name":"Mamas A Mamas","email":"","orcid":"","institution":"Keele University","correspondingAuthor":false,"prefix":"","firstName":"Mamas","middleName":"A","lastName":"Mamas","suffix":""},{"id":513745628,"identity":"497dbe11-705b-4643-bb68-607396a800ae","order_by":9,"name":"Ranim Aouda","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Ranim","middleName":"","lastName":"Aouda","suffix":""},{"id":513745629,"identity":"35b96259-cd91-40c8-9766-215443c78be1","order_by":10,"name":"Akiva Brin","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Akiva","middleName":"","lastName":"Brin","suffix":""},{"id":513745630,"identity":"2f47ad84-8f6a-44f4-95f0-d4ee6144e4c3","order_by":11,"name":"Ari Naimark","email":"","orcid":"","institution":"Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Ari","middleName":"","lastName":"Naimark","suffix":""},{"id":513745631,"identity":"636a5750-8673-41cb-850b-aa9e4c8345da","order_by":12,"name":"Amjad Abu-Salaman","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Amjad","middleName":"","lastName":"Abu-Salaman","suffix":""},{"id":513745632,"identity":"786f3619-0293-419b-b6ef-6b3efe774c50","order_by":13,"name":"Michael Glikson","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Glikson","suffix":""},{"id":513745633,"identity":"71b2d4d3-8228-46cf-b882-82ab0071b3a9","order_by":14,"name":"Elad Asher","email":"","orcid":"","institution":"The Eisenberg R\u0026D Authority, Shaare Zedek Medical Center, Hebrew University of Jerusalem","correspondingAuthor":false,"prefix":"","firstName":"Elad","middleName":"","lastName":"Asher","suffix":""}],"badges":[],"createdAt":"2025-09-03 11:23:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7526459/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7526459/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":94044186,"identity":"47039b26-cac4-4c97-84bb-0119482afe5c","added_by":"auto","created_at":"2025-10-21 20:16:14","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":615814,"visible":true,"origin":"","legend":"","description":"","filename":"PrediabetesinAcuteCoronarySyndromeAnOverlookedPredictorofAdverseOutcomes.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7526459/v1_covered_0b3c0283-090f-4699-95ad-1f7c53e149af.pdf"},{"id":91468170,"identity":"ed10ba5b-feb4-49da-904b-d9ededab4c14","added_by":"auto","created_at":"2025-09-16 19:15:26","extension":"sav","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":553914,"visible":true,"origin":"","legend":"","description":"","filename":"DanielH.data25.8.sav","url":"https://assets-eu.researchsquare.com/files/rs-7526459/v1/382f33c2be1c445def86e796.sav"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prediabetes in Acute Coronary Syndrome: An Overlooked Predictor of Adverse Outcomes","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7526459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7526459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHemoglobin A1c (HbA1c) is a well-established marker for long-term glycemic control and a diagnostic tool for diabetes mellitus (DM). The relationship between HbA1c levels and prognosis among acute coronary syndrome (ACS) patients is not well described. The aim of the current study was to evaluate the prognostic value of admission HbA1c levels in patients with ACS admitted to contemporary intensive cardiovascular care unit (ICCU).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA prospective single center study included all patients admitted to the ICCU between July 2019 and December 2024 with ACS. Patients were categorized by HbA1c levels into three groups: non-DM (\u0026lt; 5.7%), pre-DM (5.7–6.4%), and DM (≥ 6.5%). Demographics, clinical characteristics, in-hospital complications, and long-term (up to 60 months) mortality were analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 2,772 patients were admitted with a diagnosis of ACS and had HbA1c levels recorded at admission. Among them, 41.4% were non-diabetic, 29.1% had pre-diabetes, and 29.5% had diabetes. In-hospital mortality showed a gradual increase across these groups: 2.0% in non-diabetics, 1.6% in pre-diabetics, and 2.9% in diabetics (p = 0.294). Long-term mortality rose significantly with higher HbA1c categories, reaching 11.4%, 14.7%, and 18.1%, respectively (p \u0026lt; 0.001). Multivariate analysis confirmed DM as an independent predictor of mortality (HR 1.635, 95% CI: 1.280–2.08, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver half of patients admitted with an ACS have evidence of dysglycemia. Both pre-DM and DM groups were associated with increased long-term mortality in ACS patients. The findings highlight the need for greater recognition and management, especially of pre-DM ACS patients in acute cardiovascular care.\u003c/p\u003e","manuscriptTitle":"Prediabetes in Acute Coronary Syndrome: An Overlooked Predictor of Adverse Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 18:59:21","doi":"10.21203/rs.3.rs-7526459/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54e4dd52-0673-4b66-9bac-e670e3f9bd53","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-21T20:08:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-16 18:59:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7526459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7526459","identity":"rs-7526459","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}