Prediabetes in acute coronary syndrome: an overlooked predictor of adverse outcomes
Daniel Hakim1, Louay Taha1, Mohammad Karmi1
1Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Higher Hemoglobin A1c (HbA1c) levels, indicating pre-diabetes and diabetes, are linked to increased long-term mortality in acute coronary syndrome (ACS) patients. Early recognition and management of dysglycemia in ACS are crucial for improved outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Research
Background:
- Hemoglobin A1c (HbA1c) is a key marker for glycemic control and diabetes mellitus (DM) diagnosis.
- The prognostic value of HbA1c in acute coronary syndrome (ACS) patients requires further elucidation.
- This study investigates HbA1c as a predictor of mortality in intensive cardiovascular care unit (ICCU) patients with ACS.
Purpose of the Study:
- To evaluate Hemoglobin A1c (HbA1c) levels as an independent predictor of mortality in patients diagnosed with acute coronary syndrome (ACS).
- To analyze the association between different HbA1c categories (non-DM, pre-DM, DM) and long-term mortality in ACS patients admitted to an ICCU.
Main Methods:
- Retrospective single-center study of 2,772 patients admitted to the ICCU with ACS between July 2019 and December 2024.
- Patients were stratified into three HbA1c groups: non-diabetic (<5.7%), pre-diabetic (5.7-6.4%), and diabetic (≥6.5%).
- Analysis included demographics, clinical data, in-hospital complications, and up to 60-month mortality.
Main Results:
- 41.4% non-diabetic, 29.1% pre-diabetic, 29.5% diabetic patients admitted with ACS.
- Long-term mortality significantly increased with higher HbA1c levels: 11.4% (non-DM), 14.7% (pre-DM), 18.1% (DM) (p<0.001).
- Diabetes Mellitus (DM) was confirmed as an independent predictor of mortality (HR 1.635, p<0.001).
Conclusions:
- Over half of ACS patients exhibit dysglycemia (pre-DM or DM).
- Both pre-diabetes and diabetes are associated with elevated long-term mortality in ACS patients.
- Increased recognition and management of dysglycemia, particularly pre-diabetes, in ACS patients are warranted.
Background:
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 assess HbA1c levels as an independent predictor of mortality in patients with ACS admitted to contemporary intensive cardiovascular care unit (ICCU).
Methods:
A retrospective 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.
More Related Videos
05:58Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
Published on: February 3, 2021
05:58Mouse Electroacupuncture Fixation Device Fabrication for Electroacupuncture Pretreatment in Diabetic Cardiomyopathy Mouse Model
Published on: April 18, 2025
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Coronary Artery Disease I: Introduction