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Clinical Outcomes After Hospitalization for Acute Coronary Syndrome in Patients Treated with Semaglutide Versus
Nameer Ascandar1, Charles Boadu2, Gauthier Stepman2
1HCA Florida Sarasota Doctors Hospital, Sarasota, Florida.
Insights
Semaglutide treatment for obesity in acute coronary syndrome patients showed lower in-hospital mortality and shorter hospital stays compared to bariatric surgery. However, semaglutide was linked to increased acute heart failure risk.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Obesity is a growing public health concern in the US, significantly increasing the risk of cardiovascular diseases, including coronary artery disease.
- Ischemic heart disease remains the leading cause of death, highlighting the need for effective obesity interventions.
- Managing obesity is crucial for mitigating cardiovascular risks and reducing healthcare system burden.
Purpose of the Study:
- To compare the effectiveness of semaglutide treatment versus bariatric surgery in obese patients admitted for acute coronary syndrome (ACS).
- To analyze outcomes such as in-hospital mortality, heart failure, hospital stay duration, and revascularization rates.
Main Methods:
- A retrospective study utilizing the HCA Healthcare enterprise data warehouse.
- Inclusion of adult patients treated for obesity with either semaglutide or bariatric surgery, admitted for ACS.
- Descriptive and regression analyses were performed to evaluate primary and secondary outcomes.
Main Results:
- The semaglutide group (67.1%) had lower in-hospital mortality (AOR, 0.61) and shorter hospital stays (1.5 days) compared to the bariatric surgery group (32.9%).
- Semaglutide use was associated with higher odds of acute heart failure (AOR, 3.45) but also higher odds of achieving revascularization via PCI (AOR, 1.19).
- The semaglutide cohort was generally older, more likely male, nonwhite, and less frequently smokers than the bariatric surgery cohort.
Conclusions:
- Semaglutide use in obese ACS patients is linked to reduced in-hospital mortality and shorter hospitalizations compared to bariatric surgery.
- While associated with increased acute heart failure risk, semaglutide also demonstrated improved revascularization rates.
- Semaglutide presents a potential alternative for managing major adverse events in obese individuals at risk for ischemic heart disease.
Background:
Obesity is a chronic medical condition with a rising prevalence in the United States. A wide range of morbidity and mortality is associated with obesity, with coronary artery disease being among the most common. Ischemic heart disease continues to be the primary cause of death in the United States. Taken together, interventions to minimize the detrimental effects of obesity on patients at risk of heart disease will not only benefit the patient, but the health care system as well.
Methods:
In this retrospective study, we used the HCA Healthcare enterprise data warehouse to identify all adult patients who were admitted for acute coronary syndrome (ACS) and were currently or previously treated for obesity with either semaglutide or bariatric surgery. Descriptive and regression analysis were performed to examine our primary and secondary outcomes of interest.
Results:
Of 10 316 total patients who met inclusion criteria, 6920 (67.1%) were in the semaglutide group and 3396 (32.9%) were in the bariatric surgery group. The semaglutide cohort was on average older, more frequently men, nonwhite race, and less frequently smokers compared with the bariatric surgery group. Results of regression analysis showed the semaglutide group was associated with lower odds of in-hospital mortality (AOR, 0.61; 95% CI, 0.41-0.92) and higher odds of acute heart failure (AOR, 3.45; 95% CI, 2.2-5.4) compared to bariatric surgery. Furthermore, negative binomial regression showed a 1.5 shorter duration of hospital stay for the semaglutide cohort following inpatient admission for ACS compared with the bariatric group. The semaglutide cohort was linked with higher odds of achieving revascularization via percutaneous coronary intervention (AOR, 1.19; 95% CI, 1.04-1.35) compared with the bariatric surgery group. Lastly, the semaglutide group was associated with higher odds of acute heart failure (3.45; 2.19-5.44) compared with the bariatric surgery group.
Conclusion:
Semaglutide use was associated with lower in-hospital mortality and shorter duration of hospital stay but higher odds of acute heart failure compared with patients who had prior bariatric surgery. Semaglutide use was associated with higher odds of acquiring revascularization. Lastly, semaglutide may be an effective alternative to prevent major adverse events in obese patients at risk of ischemic heart disease.
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