Eligibility for and practical implications of Semaglutide in overweight and obese patients with acute coronary syndrome

📖 Top 20% JournalJan 31, 2025International journal of cardiology

Who can use Semaglutide and its practical benefits for overweight and obese patients with recent heart attack or chest pain

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Abstract

In a cohort of 2940 acute coronary syndrome patients, 27.4% were eligible for semaglutide based on SELECT trial criteria.

807 patients met the eligibility criteria for semaglutide, while 2133 were not eligible.
The incidence of major adverse cardiovascular events (MACE) at 1 year was significantly lower in the eligible group (4.6%) compared to the ineligible group (8.2%).
The incidence of net adverse clinical events (NACE) was also lower in the SELECT-like group (3.6%) versus the not-eligible group (7.6%).
Findings suggest that semaglutide may be applicable for secondary prevention in eligible post-ACS patients.

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AIMS: Semaglutide has been shown to reduce cardiovascular events in non-diabetic patients with preexisting cardiovascular disease and overweight/obesity in the SELECT trial. Data on the applicability of these results to clinical practice are limited. We evaluated the eligibility for and practical implications of semaglutide in overweight/obese non-diabetic patients with recent acute coronary syndrome (ACS) from a contemporary real-world registry.

METHODS: Patients from the multicenter START-ANTIPLATELET registry (NCT02219984) were stratified to investigate the proportion of patients eligible for semaglutide >60 days after discharge for ACS (post-acute phase), according to the SELECT trial eligibility criteria: age ≥ 45 years; body mass index ≥27 kg/m; history of myocardial infarction (MI), stroke, or peripheral artery disease; no diabetes. Major adverse cardiovascular events (MACE), defined as a composite of all-cause death, MI, target vessel revascularization, or stroke, and net adverse clinical events (NACE), a composite of all-cause death, MI, stroke, or major bleeding, were assessed at 1-year follow-up. 2

RESULTS: The study population comprised 2940 consecutive ACS patients. At 60 days after discharge, 807 patients (27.4 %) met the SELECT eligibility criteria (SELECT-like group) and 2133 patients were ineligible (not-eligible group). At 1 year, incidence of MACE (4.6 % vs. 8.2 %; p = 0.004) and NACE (3.6 % vs. 7.6 %; p < 0.001) was lower in the SELECT-like group compared to the not-eligible group.

CONCLUSIONS: In a contemporary real-world registry, a significant proportion of post-ACS patients were eligible for semaglutide according to the SELECT trial criteria. Future studies are needed to evaluate the potential implications of semaglutide for secondary prevention.

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