Clinical Outcomes After Hospitalization for Acute Coronary Syndrome in Patients Treated with Semaglutide Versus Bariatric Surgery: A Retrospective Multicenter Analysis.

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.