De Sio Vincenzo, Gragnano Felice, Capolongo Antonio, Guarnaccia Natale, Maddaluna Pasquale, Acerbo Vincenzo, Galli Mattia, Berteotti Martina, Sperlongano Simona, Cesaro Arturo, Moscarella Elisabetta, Pelliccia Francesco, Patti Giuseppe, Antonucci Emilia, Cirillo Plinio, Pignatelli Pasquale, Palareti Gualtiero, Pengo Vittorio, Gresele Paolo, Marcucci Rossella, Calabrò Paolo
Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Caserta, Italy; Division of Clinical Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", Caserta, Italy.
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
Int J Cardiol. 2025 Mar 15;423:133028. doi: 10.1016/j.ijcard.2025.133028. Epub 2025 Jan 29.
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.
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.
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.
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.
在SELECT试验中，司美格鲁肽已被证明可降低患有心血管疾病且超重/肥胖的非糖尿病患者的心血管事件。关于这些结果在临床实践中的适用性数据有限。我们从一个当代真实世界登记处评估了司美格鲁肽在近期患有急性冠状动脉综合征（ACS）的超重/肥胖非糖尿病患者中的适用性及实际影响。
根据SELECT试验的入选标准，将多中心START - 抗血小板登记处（NCT02219984）的患者进行分层，以调查ACS出院后60天以上有资格使用司美格鲁肽的患者比例（急性期后）：年龄≥45岁；体重指数≥27kg/m²；有心肌梗死（MI）、中风或外周动脉疾病史；无糖尿病。在1年随访时评估主要不良心血管事件（MACE，定义为全因死亡、MI、靶血管血运重建或中风的综合）和净不良临床事件（NACE，全因死亡、MI、中风或大出血的综合）。
研究人群包括2940例连续的ACS患者。出院60天时，807例患者（27.4%）符合SELECT入选标准（SELECT样组），2133例患者不符合标准（不符合组）。1年时，SELECT样组的MACE发生率（4.6%对8.2%；p = 0.004）和NACE发生率（3.6%对7.6%；p < 0.001）低于不符合组。
在当代真实世界登记处中，根据SELECT试验标准，相当比例的ACS后患者有资格使用司美格鲁肽。未来需要进行研究以评估司美格鲁肽对二级预防的潜在影响。
