Use of semaglutide after acute coronary syndrome: an exploratory retrospective study

Aims Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated cardiovascular benefit in patients with type 2 diabetes mellitus (T2DM) and established atherosclerotic disease. Its role in the immediate postacute coronary syndrome (ACS) setting, however, remains unexplored. This study evaluated the early real-world use of semaglutide prescribed at hospital discharge after ACS. Methods We conducted a retrospective, multicenter observational study of adults with T2DM hospitalized for ACS between January 2022 and December 2024 and discharged with a prescription for semaglutide. Baseline demographics, therapies, and ACS features were collected together with follow-up data on treatment persistence, reasons for discontinuation, adverse events, metabolic parameters, and cardiovascular outcomes. Results A total of 60 patients (mean age 61.1 ± 10.8 years, 73% male) were included. At discharge, all received semaglutide (83.3% injectable, 16.7% oral) at the lowest dose. At the first follow-up (108 ± 39 days), 81% remained on therapy; discontinuations occurred mainly for gastrointestinal intolerance (15%). Body weight decreased by 4.7 ± 1.6 kg, BMI decreased by 1.7 ± 0.6 kg/m 2 , and HbA1c improved from 64.3 ± 18.2 to 49.6 ± 10.4 mmol/mol. At the second follow-up (278 ± 60 days, n = 39), 97.4% were still on semaglutide. Additional weight loss (−2.6 ± 3.8 kg) and further HbA1c reduction (40.5 ± 18.6 mmol/mol) were observed. No cardiovascular events, renal decline, or pancreatic events were reported. Conclusions In this exploratory real-world cohort, initiating semaglutide at hospital discharge after ACS was feasible, well tolerated, and associated with high persistence and early cardiometabolic improvements.