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Background: There is increasing evidence that cardiovascular disease risk starts rising from the stage of prediabetes. Our aim was to study the relationship of prediabetes with coronary artery disease (CAD) severity and whether the degree of glycaemia impacts the severity of CAD. Methods: In this cross-sectional study patients admitted with acute coronary syndrome (ACS) who had impaired fasting glucose (IFG) were studied. Coronary angiography (CAG) severity was calculated using Gensini scoring system. Their glycaemic status was reclassified and reanalysed after 1 month using oral glucose tolerance test. Glycaemic status was then correlated with CAD severity. Results: Of the 140 patients studied, at 1 month follow-up, only 94 persisted in the IFG category; Stress hyperglycaemia (SH) was evident in 32.8%. A moderate positive correlation (0.4) was observed between Gensini score and 2h PPG as compared to that with FBS (0.18) and glycosylated haemoglobin (HbA1c) (0.1). Multiple linear regression showed only 2h postprandial blood glucose (2h-PPBG) had a significant correlation with Gensini score (adjusted odds ratio 1.006). Conclusions: SH, being a major confounding factor during acute coronary events, demands revisiting patients' glycaemic status after 1 month for correct classification. Significant correlation was found between CAD severity and IGT. This highlights the importance of assessing 2h-PPBG in predicting the risk of macrovascular complications like ACS even in prediabetic individuals. [ABSTRACT FROM AUTHOR]