Retrospective TriNetX cohort study examining early GLP-1 RA (tirzepatide or semaglutide) initiation within 14 days post-AMI in T2DM patients (January 2017–December 2023), using propensity score matching to compare cardiovascular outcomes versus matched non-initiators. Tests whether early post-AMI GLP-1 RA initiation is safe and effective in real clinical practice. Provides real-world evidence for immediate post-AMI GLP-1 RA initiation strategy—informing whether tirzepatide or semaglutide should be started before hospital discharge to maximize secondary cardiovascular prevention in T2DM patients.
Abstract
AIMS: Acute myocardial infarction (AMI) is among the leading causes of mortality in patients with type 2 diabetes (T2DM). This study evaluated whether initiation of glucagon-like peptide-1 receptor agonists (GLP1RAs) post-AMI improves cardiovascular outcomes in this population.
METHODS: This retrospective cohort study used the TriNetX Research Network to identify adult patients with T2DM who experienced an AMI between January 1, 2017, and December 31, 2023. Patients were included if they initiated tirzepatide or semaglutide within 14 days post-AMI. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was recurrent coronary events, and secondary outcomes included all-cause mortality and hospitalizations, heart failure (HF) hospitalizations, acute kidney injury (AKI), and cardiac arrest. Hazard ratios (HR) were estimated using Cox proportional hazard models.
RESULTS: 5338 patients were included in each cohort. Mean follow-up was 327.7 days (GLP1RA group) vs. 307.9 days (non-GLP1RA group). GLP1RA use did not significantly reduce recurrent coronary events (3.7 % vs 3.8 %; HR 0.913, 95 % CI 0.750-1.111). GLP1RA use was associated with significantly lower all-cause mortality (HR 0.484, 95 % CI 0.413-0.567), HF hospitalizations (HR 0.578, 95 % CI 0.531-0.630), AKI (HR 0.688, 95 % CI 0.610-0.732), cardiac arrest (HR 0.549, 95 % CI 0.418-0.722), and all-cause hospitalizations (HR 0.673, 95 % CI 0.636-0.713).
CONCLUSIONS: GLP1RA initiation in patients with T2DM post-AMI was not associated with a reduction in recurrent coronary events, but was linked to improvements in other cardiovascular outcomes, suggesting a potential role for GLP1RAs as part of a secondary prevention strategy.