## 4 Discussion  
The main findings of the present study are (1) the prevalence of preT2D is high among AMI patients, especially when ADA criteria are applied (2) preT2D and T2D are correlated with a progressively growing number of CV risk factors according to increased HbA1c values; (3) T2D patients, but not the preT2D, were significantly associated with adverse prognosis in terms of in-hospital or one-year death. For many patients, the AMI hospitalization represents a period in which previously unrecognized glucidic abnormalities may be diagnosed. Thanks to improvements in laboratory standardization, the utilization of HbA1c as a diagnostic test for dysglycemia in addition to the traditional criteria based on fasting plasma glucose or oral glucose tolerance testing has been suggested [2; 7]. However, there were differences in the criteria of defining preT2D between ADA and WHO. These differences may be particularly critical in specific CV settings, as in AMI, where the HbA1c test may be more practical because its measurement does not require a fasting status, and as a long-term glycemic biomarker HbA1c is less affected than glucose by acute stress and illness [8]. Moreover, HbA1c may represent a better tool in predicting CV risk, as this biomarker is more strongly associated with CV risk and death when compared with fasting glucose [9]. In the current study, we observed that majority of AMI patients had dysglycemia, with a prevalence of preT2D of 29 and 12% according to HbA1c ADA and WHO criteria, respectively. A comparable preT2D prevalence in AMI patients of 11% was previously found in agreement with our WHO definition finding, utilizing the criteria of fasting glucose \(\geq\)110 to \(<\)126 mg/dL for preT2D definition [10]. In any case, this high prevalence of pre-T2D in AMI patients gives the theoretical chance to identify patients who may benefit more from lifestyle change or therapeutical interventions (e.g., metformin) to prevent progression to overt T2D, and reduce the risk of adverse CV events [11]. This is important also in view of evidence suggesting that preT2D may develop in overt T2D with an approximately 5-10% annual risk, whereas lifestyle modification in preT2D patients is associated with 40-70% relative-risk reduction [12]. Moreover, this fact may be relevant, as generally subjects with preT2D, even those admitted with AMI, receive less aggressive treatment than those with T2D, often due to physician unawareness of their potentially high CV risk, representing a high-risk population under-recognized and under-treated. Interestingly, there was a higher prevalence of preT2D among females (37% versus 26% in males, \(<\)0.001: unshown data), associated with a higher prevalence of hypertension (68 versus 53% in males, \(<\)0.001: unshown data) in our population. Previous studies have reported hypertension to be associated with preT2D further increasing the risk of CV disease [13; 14; 15], which may have particular significance in female patients, giving an early opportunity to intervene with lifestyle and therapeutic measures for health maintenance and T2D and CV disease prevention, especially in this specific subgroup of patients. In the present study, the risk for in-hospital and one-year mortality was approximately triple and double, respectively for patients with compared with those without T2D. This result confirms previous data suggesting that the risk for death and other adverse events is approximately double for acute and stable coronary artery disease coronary patients with T2D versus without T2D [16; 17]. However, the risk for patients with preT2D was similar to that of patients with noT2D. Also, this result is in agreement with previous findings suggesting that patients with preT2D have a better CV prognosis compared with those with T2D [16; 17]. In this context, it is clear that T2D duration and cumulative preT2D hyperglycemic insults among patients with long-standing T2D acquire critical importance for the risk of adverse outcomes [18; 19; 20; 21].