Semaglutide in non-diabetic obese Chinese patients with acute coronary syndrome: a multicenter retrospective study

This study aimed to assess clinical benefits of semaglutide for East Asian non-diabetic obese patients with ACS who have undergone percutaneous coronary intervention (PCI) . This was a multicenter retrospective cohort study. A total of 344 non-diabetic obese patients with ACS who underwent PCI at three hospitals from May 2020 to December 2024 were enrolled (semaglutide group:112 patients, control group: 232 patients). Propensity score matching (PSM) was performed to balance the baseline data between the two groups. The primary endpoint was 6-month major adverse cardiovascular events (MACE), and secondary endpoints included dynamic changes in cardiac troponin I (cTnI) and alterations in metabolic and left ventricular ejection fraction (LVEF) at 6-month follow-up. After PSM, compared with the control group, the semaglutide group had lower rates of the 6-month MACE (11.6% vs. 23.2%, p = 0.034) and unplanned revascularization (4.7% vs. 13.4%, p = 0.033), and and showed faster improvement in cTnI levels. Both groups showed improvements in blood lipid profiles and LVEF post-PCI. Additionally, the semaglutide group achieved further reductions in fasting blood glucose (FBG) (5.74 ± 0.60mmol/L vs. 5.25 ± 0.43mmol/L, p < 0.0001), glycated hemoglobin (HbA1c) (5.43 ± 0.59% vs. 5.18 ± 0.50%, p = 0.016) and body mass index (BMI) (30.94 ± 1.69 kg/m²vs. 28.45 ± 2.82 kg/m², p < 0.0001). Particularly, the magnitudes of improvements in BMI (2.49 ± 3.27 kg/m²vs. 0.78 ± 2.76 kg/m², p = 0.002), FBG (0.49 ± 0.75mmol/L vs. 0.03 ± 0.83mmol/L, p < 0.0001), LDL-C (1.78 ± 1.22mmol/L vs. 0.83 ± 0.94mmol/L, p < 0.0001), TG (0.98 ± 1.02mmol/L vs. 0.63 ± 0.70mmol/L, p = 0.003) and LVEF (5.73 ± 8.07% vs. 2.66 ± 8.09%, p = 0.005) in the semaglutide group were significantly superior to those in the control group. Semaglutide treatment was associated with a lower 6-month MACE and favorable changes in metabolic and cardiac function in non-diabetic obese ACS patients post-PCI. These observational findings provide real-world evidence for further study. This was a retrospective study, so clinical trial registration was not applicable.