Semaglutide in Non-diabetic Obese East Asian Patients with Acute Coronary Syndrome: A Multicenter Retrospective Study

Semaglutide in Non-diabetic Obese East Asian Patients with Acute Coronary Syndrome: A Multicenter Retrospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Semaglutide in Non-diabetic Obese East Asian Patients with Acute Coronary Syndrome: A Multicenter Retrospective Study Chao-lun Jin, Lu Huang, Ying-ying Wei, Yun-shu Xu, Bo Zhang, Jing Wu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9161583/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 19 You are reading this latest preprint version Abstract Objective 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) . Method 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. Results After PSM, the 6-month MACE (11.6% vs. 23.2%, p = 0.034) and unplanned revascularization (4.7% vs. 13.4%, p = 0.033) in the semaglutide group were significantly lower than those in the control group, and the improvement in cTnI levels was faster in the semaglutide group. 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. Conclusions Semaglutide can reduce 6-month MACE risk and improve metabolic and cardiac function in non-diabetic obese ACS patients post-PCI, providing real-world evidence for clinical intervention. Clinical trial registration This was a retrospective study, so clinical trial registration was not applicable. Semaglutide Non-diabetic Obese Acute Coronary Syndrome Outcomes Figures Figure 1 Figure 2 Figure 3 Introduction The global prevalence of obesity continues to rise, according to statistics from the World Health Organization (WHO), the proportion of obese people worldwide exceeded 18% in 2025 [ 1 ]. As an independent risk factor for cardiovascular diseases, obesity can significantly increase the incidence of acute coronary syndrome (ACS) and the probability of adverse prognosis by inducing insulin resistance, inflammatory responses, endothelial dysfunction, and the progression of coronary atherosclerosis [ 2 – 3 ]. Clinical data indicate that compared with ACS patients with normal weight, obese ACS patients without diabetes have a 42% higher incidence of heart failure during hospitalization, a 35% higher 30-day readmission rate, and a 28% higher 1-year all-cause mortality rate [ 4 ], making this a pressing clinical challenge to be addressed in the field of cardiology. Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), was initially used for glycemic control in patients with type 2 diabetes mellitus (T2DM) [ 5 ]. Later, it was approved for obesity management due to its proven weight-loss effect and evidence of cardiovascular protection[ 5 ]. The SUSTAIN-6 study confirmed that semaglutide can reduce the risk of major adverse cardiovascular events (MACE) by 26% in T2DM patients [ 6 ]. Subsequent STEP trials further demonstrated that it can achieve a 15%–18% body weight reduction in non-diabetic obese populations, along with improvements in metabolic indicators such as blood pressure and blood lipids [ 7 – 10 ]. However, current clinical evidence regarding semaglutide in obese ACS patients without diabetes remains limited, and there is no clear conclusion on whether semaglutide can reduce the risk of adverse prognosis through mechanisms such as weight loss, anti-inflammation, and improvement of myocardial remodeling. Based on this, this study retrospectively analyzed the clinical data of obese ACS patients without diabetes, compared the prognostic differences between those treated with semaglutide and those without semaglutide treatment, aiming to provide real-world evidence for the drug intervention strategies in this population. Methods Participants This was a multi-center retrospective cohort study. The participants were obese patients without diabetes who were diagnosed with ACS and underwent percutaneous coronary intervention (PCI) during hospitalization in the department of cardiology at three hospitals (Hangzhou Ninth People's Hospital, Hangzhou Geriatric Hospital, Hangzhou Tenth People's Hospital) in China between May 2020 and December 2024. (1) Inclusion Criteria: 1) Body mass index (BMI) ≥ 28 kg/m²; 2) Patients meeting the diagnostic criteria for ACS, which included: Typical chest pain symptoms; Cardiac troponin I (cTnI) levels exceeding the 99th percentile of the upper reference limit; Electrocardiogram (ECG) showing ST-segment elevation or dynamic changes, or coronary angiography demonstrating coronary artery occlusion or severe stenosis (≥ 70%). (2) Exclusion Criteria: 1) Complicated with type 1 diabetes mellitus (T1DM), T2DM or gestational diabetes mellitus; Severe hepatic or renal insufficiency; 2)Personal or family history of medullary thyroid carcinoma contraindication to semaglutide administration); 3) A history of severe gastrointestinal diseases (e.g., intractable nausea and vomiting, gastroparesis); 4) Follow-up duration of less than 6 months or incomplete follow-up data. This is a retrospective study; therefore, no clinical trial registration was performed. Grouping method Semaglutide group: Patients received subcutaneous injection of semaglutide injection (1.34 mg/mL) starting on the first day after PCI. The dosage regimen was as follows: 0.25 mg once weekly for weeks 1–4 (titration phase); 1.0 mg once weekly for weeks 5–52. Control group: Patients did not receive semaglutide injection. Outcomes The primary endpoint of this study was the occurrence of MACE within 6 months after PCI. MACE was defined as a composite endpoint consisting of cardiac death, non-fatal recurrent acute myocardial infarction (AMI, confirmed by AMI diagnostic criteria), unplanned revascularization, and readmission due to heart failure (HF). The secondary endpoints included: 1) The dynamic changes in cTnI levels during hospitalization; 2) Changes in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), BMI, lipid profiles and left ventricular ejection fraction (LVEF) at the 6-month follow-up; The diagnosis of AMI was made in accordance with the guidelines specified in the Fourth Universal Definition of MI [ 11 ]. The diagnostic criteria for obesity were defined as a BMI ≥ 28 kg/m². The definition of non-diabetic status was: FBG < 7.0 mmol/L on admission, HbA1c < 6.5%, no prior history of T2DM or T1DM, and no history of hypoglycemic agent administration. Cardiac death was defined as death attributable to a definite cardiac cause, unwitnessed death, or death of unknown etiology. The diagnosis of ischemia-driven target lesion revascularization (iTLR) and confirmed/suspected stent thrombosis at the 6-month follow-up was determined in accordance with the Academic Research Consortium (ARC) criteria. Data collection Data were collected from the hospital electronic medical record (EMR) system and follow-up management platform, including the following patient information: 1) Baseline characteristics: age, gender, BMI, history of smoking, drinking, hypertension, coronary heart disease(CHD); 2) Laboratory parameters: FBG, HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), cTnI; 3) ACS subtype:(unstable angina[UA], ST segment elevation myocardial infarction [STEMI], non-ST-elevation myocardial infarction [NSTEMI]); 4) Culprit vessel; Concomitant medications (aspirin, clopidogrel/ticagrelor, statins, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers[ACEI/ARB], mineralocorticoid receptor antagonists). Follow-up The dynamic changes in cTnI levels were monitored during hospitalization. Telephone follow-up was conducted at 1 month and 3 months after discharge, and outpatient follow-up was performed at 6 months. Changes in HbA1c, FBG, LVEF, blood lipid profiles and BMI were recorded, and the occurrence of endpoint events was confirmed. Statistical Analysis Continuous variables were expressed as means ± standard deviation (SD) and compared using the Student's t-test. Categorical variables were expressed as frequencies and percentages and compared using the chi-squared test or Fisher's exact test. To minimize potential bias, propensity score matching (PSM) was performed at a 1:1 ratio between the semaglutide group and the control group. All statistical tests were two-tailed, and a p-value < 0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics version 29. Results Baseline characteristics A total of 344 patients were enrolled in this study and completed 6 months of follow-up. Among them, 112 patients (32.6%) received semaglutide treatment post-PCI, while 232 patients (67.4%) did not receive semaglutide treatment. Patients in the semaglutide group exhibited the following characteristics: older age, higher proportion of males, higher BMI, lower HbA1c and FBG, higher LDL-C, lower LVEF; meanwhile, the proportion of patients with NSTEMI was higher in the semaglutide group. No significant differences were observed between the two groups in terms of perioperative procedures and medication regimens. After PSM, baseline and procedural characteristics were well balanced between two groups (Table 1 ). Details of procedural characteristics and outcomes are shown in Table 2 . Table 1 Baseline clinical characteristics in the Semaglutide and control groups before and after propensity score matching All patients Propensity-matched patients Semaglutide (n = 112) Control (n = 232) p-value Semaglutide (n = 112) Control (n = 112) p-value Male sex, n (%) 61 (54.5%) 118 (50.8%) < 0.001 61 (54.5%) 57 (50.9%) 0.723 Age, years 69.5 ± 12.3 66.9 ± 10.8 < 0.001 69.5 ± 12.3 67.9 ± 10.8 0.312 BMI, kg/m2 30.9 ± 1.7 29.80 ± 2.2 < 0.001 30.9 ± 1.7 30.7 ± 2.1 0.451 Type of ACS UA, n (%) 57 (50.9%) 132(56.9%) < 0.001 57 (50.9%) 59(52.7%) 0.112 NSTEMI, n (%) 31 (27.7%) 55 (23.7%) < 0.001 31 (27.7%) 31(27.7%) 1 STEMI, n (%) 24 (21.4%) 45 (19.4%) 0.065 24 (21.4%) 22 (19.6%) 0.241 Culprit vessel LMCA, n (%) 13(11.6%) 17(7.3%) < 0.001 13(11.6%) 11(9.8%) 0.215 LAD, n (%) 38(33.9%) 94(40.5%) < 0.001 38(33.9%) 41(36.6%) 0.187 LCX, n (%) 31(27.7%) 56(24.2%) 0.013 31(27.7%) 26(23.2%) 0.053 RCA, n (%) 30 (26.8%) 65(28.0%) 0.025 30 (26.8%) 34 (30.4%) 0.021 HbA1c, % 5.43 ± 0.59 6.21 ± 1.61 0.005 5.43 ± 0.59 5.68 ± 0.60 0.432 FBG 5.74 ± 0.60 5.86 ± 0.31 0.015 5.74 ± 0.60 5.53 ± 0.43 0.171 Lipids, mg/L TC 5.17 ± 0.85 5.62 ± 1.63 0.011 5.17 ± 0.85 5.16 ± 1.12 0.333 HDL-c 1.25 ± 0.54 1.45 ± 1.01 0.121 1.25 ± 0.54 1.21 ± 0.60 0.921 LDL-c 3.55 ± 1.03 3.12 ± 0.98 < 0.001 3.55 ± 1.03 3.50 ± 0.82 0.811 TG 2.50 ± 0.82 2.91 ± 1.02 < 0.001 2.50 ± 0.82 2.50 ± 0.53 0.105 LVEF (%) 49.9 ± 8.11 55.2 ± 6.25 < 0.001 49.9 ± 8.11 53.1 ± 6.26 0.313 History of CVD, n (%) CHD, n (%) 26 (23.4%) 46 (20.2%) 0.111 15.0 (13.4%) 18.0 (16.1%) 0.111 Stroke, n (%) 17(15.1%) 33(14.3) 0.231 Hypertension, n (%) 30(27.0%) 58 (25.1%) 0.108 19.0 (17.0%) 16.0 (14.3%) 0.099 Smoking 18(16.1%) 47 (20.3%) 0.9999 107(95.8%) 106(94.6%) > 0.9999 Clopidogrel 85(76.0%) 183(78.9%) 0.5796 85(76.0%) 86(76.7%) > 0.9999 Ticagrelor 26(23.3%) 49(21.1%) 0.6773 26(23.3%) 25(22.3%) > 0.9999 β-blockers 81(72.4%) 151(65.2%) 0.2195 81(72.4%) 76(%) 0.5596 ACEI 63(56.3%) 128(55.2%) 0.9080 63(56.3%) 68(%) 0.5877 ARB 19(17.0%) 40(17.3%) > 0.9999 19(17.0%) 17(15.2%) 0.8559 Statins 110(98.2%) 226(97.4%) > 0.9999 110(98.2%) 111(%) > 0.9999 Note: Values are n (%) or mean ± SD. BMI: Body Mass Index;ACS: Acute coronary syndrome; UA༚Unstable angina༛NSTEMI༚Non-ST-segment elevation myocardial infarction༛STEMI༚ST-segment elevation myocardial infarction; FBG༚Fasting blood glucose༛CVD: Cardiovascular disease; CHD: Coronary heart disease; TC:Total cholesterol; TG:Triglycerides༛LMCA༚left main coronary artery; LAD:left anterior descending artery; LCX:left circumflex artery; LVEF:Left Ventricular Ejection Fraction; HDL-c: High-density lipoprotein cholesterol; LDL-c:Low-density lipoprotein cholesterol; ACEI: Angiotensin-converting enzyme inhibitors; ARB: Angiotensin receptor blockers. Table 2 Angiographic and procedural results in the Semaglutide and control groups before and after propensity score matching All patients Propensity-matched patients Semaglutide (n = 112) Control (n = 232) p-value Semaglutide (n = 112) Control (n = 112) p-value Culprit vessel LMCA, n (%) 13(11.6%) 17(7.3%) 0.221 13(11.6%) 11(9.8%) 0.829 LAD, n (%) 38(33.9%) 94(40.5%) 0.287 38(33.9%) 41(36.6%) 0.780 LCX, n (%) 31(27.7%) 56(24.2%) 0.509 31(27.7%) 26(23.2%) 0.540 RCA, n (%) 30 (26.8%) 65(28.0%) 0.898 30 (26.8%) 34 (30.4%) 0.657 Stents per patient 5.49 ± 0.57 6.21 ± 1.61 0.005 5.49 ± 0.57 5.81 ± 0.61 0.432 Total length of stent 5.69 ± 0.58 5.86 ± 0.31 0.015 5.69 ± 0.58 5.56 ± 0.61 0.171 Note: Values are n (%) or mean ± SD. BMI: Body Mass Index;ACS: Acute coronary syndrome; UA༚Unstable angina༛NSTEMI༚Non-ST-segment elevation myocardial infarction༛STEMI༚ST-segment elevation myocardial infarction; FBG༚Fasting blood glucose༛CVD: Cardiovascular disease; CHD: Coronary heart disease; TC:Total cholesterol; TG:Triglycerides༛LMCA༚left main coronary artery; LAD:left anterior descending artery; LCX:left circumflex artery; LVEF:Left Ventricular Ejection Fraction; HDL-c: High-density lipoprotein cholesterol; LDL-c:Low-density lipoprotein cholesterol. Clinical outcomes Primary endpoint Before PSM, compared with the control group, patients treated with semaglutide had a significantly lower incidence of MACE at 6 months (11.6% vs. 21.1%, p = 0.036 ). The proportion of unplanned revascularization in semaglutide-treated patients was significantly lower than that in the control group (4.7% vs. 7.3%, p = 0.045), whereas no significant differences were noted between the two groups in cardiac death (1.8% vs. 1.7%, p = 0.236), non-fatal recurrent AMI (1.8% vs. 3.9%, p = 0.067), and HF hospitalization (3.6% vs. 8.2%, p > 0.9999) (Table 3 and Fig. 1A-E). After PSM, the 6-month MACE incidence in the semaglutide group remained significantly lower than that in the control group (11.6% vs. 23.2%, p = 0.034). This difference was mainly attributed to the markedly lower incidence of unplanned revascularization in the semaglutide group compared with the control group (4.7% vs. 13.4%, p = 0.033). No significant differences were detected between the two groups in cardiac death (1.8% vs. 3.6%, p > 0.9999), non-fatal recurrent AMI (1.8% vs. 3.6%, p = 0.683), and HF hospitalization (3.6% vs. 5.4%, p > 0.9999) (Table 3 and Fig. 1F-J). Table 3 Clinical outcomes in the semaglutide and control groups before and after propensity score matching. All patients Propensity-matched patients Semaglutide (n = 112) Control (n = 232) p-value Semaglutide (n = 112) Control (n = 112) p-value MACE 13(11.6%) 49(21.1%) 0.036 13(11.6%) 26(23.2%) 0.034 Cardiac death, n (%) 2(1.8%) 4(1.7%) 0.236 2(1.8%) 3(3.6%) > 0.9999 MI, n (%) 2(1.8%) 9(3.9%) 0.067 2(1.8%) 4(3.6%) 0.683 Revascularization, n (%) 5(4.7%) 26(7.3%) 0.045 5(4.7%) 15(13.4%) 0.033 HF hospitalization, n (%) 4(3.6%) 10(8.2%) > 0.9999 4(3.6%) 3(5.4%) > 0.9999 Note: Values are n (%) or mean ± SD. MACE:Major Adverse Cardiovascular Events; MI:myocardial infarction; HF:heart failure. Secondary endpoint Analysis of the dynamic changes in cTnI revealed that the decline rate of cTnI in the semaglutide group was significantly faster than that in the control group(Fig. 2). Follow-up assessments of metabolic indicators and cardiac function showed that in the control group, LDL-C (3.50 ± 0.82mmol/L vs. 2.67 ± 0.43mmol/L, p < 0.0001, ), TC (5.16 ± 1.12mmol/L vs. 4.62 ± 1.31mmol/L, p = 0.031), and TG (2.50 ± 0.54mmol/L vs. 1.87 ± 0.41mmol/L, p < 0.0001) decreased significantly, and LVEF was improved (53.13 ± 6.26% vs. 55.60 ± 5.67%, p = 0.038) (Fig. 2). In the semaglutide group, significant reductions were observed in BMI (30.94 ± 1.69kg/m²vs. 28.45 ± 2.82 kg/m², p < 0.0001), HbA1c (5.43 ± 0.59% vs. 5.18 ± 0.50%, p = 0.016), FBG (5.74 ± 0.60mmol/L vs. 5.25 ± 0.43mmol/L, p < 0.0001), LDL-C (3.53 ± 1.03mmol/L vs. 1.77 ± 0.59mmol/L, p < 0.0001), TC (5.17 ± 0.84mmol/L vs. 4.63 ± 1.04mmol/L, p = 0.001), and TG (2.50 ± 0.82mmol/L vs. 1.52 ± 0.63mmol/L, p < 0.0001), along with a marked improvement in LVEF (49.93 ± 8.11% vs. 54.42 ± 4.36%, p < 0.0001) (Fig. 2). Additionally, we found that the improvement magnitudes of 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) (Fig. 3) in the semaglutide group were significantly superior to those in the control group. Discussion This multicenter retrospective cohort study aimed to explore the prognostic value of semaglutide in non-diabetic obese patients with ACS who underwent PCI. The key findings demonstrated that compared with the control group, semaglutide treatment significantly reduced the incidence of 6-month MACE and unplanned revascularization both before and after PSM. In addition, semaglutide accelerated the decline rate of cTnI during hospitalization, and its efficacy in improving metabolic indicators and LVEF was significantly superior to that of the control group. As a well-recognized independent risk factor for CHD, obesity exacerbates the pathological progression of ACS through multiple pathways including insulin resistance, chronic inflammation, and endothelial dysfunction, thereby increasing the risk of adverse prognosis [ 12 ]. Previous clinical studies have confirmed that non-diabetic obese patients with ACS have significantly higher in-hospital heart failure incidence, readmission rate, and long-term mortality, which poses a severe challenge to clinical treatment [ 8 , 13 – 14 ]. As a GLP-1 RA, semaglutide’s weight-loss and cardioprotective effects have been extensively validated in patients with T2DM and non-diabetic obese populations [ 5 , 15 ]. However, previous relevant evidence has mostly focused on non-ACS populations, and the role of semaglutide in non-diabetic obese patients with ACS remains unclear. The present study found that semaglutide treatment significantly reduced the 6-month MACE incidence in this specific population, which is consistent with the cardioprotective effects observed in previous studies, suggesting that the cardioprotective potential of semaglutide may be extended to non-diabetic obese patients with ACS. Notably, the significant reduction in MACE and unplanned revascularization in the semaglutide group was observed in this study, whereas there were no significant differences between the two groups in the incidence of other endpoint events such as cardiac death, recurrent myocardial infarction, and heart failure readmission. This finding may be associated with the following mechanisms: First, the indirect effect of semaglutide’s weight-loss property [ 5 ]. The study showed that the reduction amplitude of BMI in the semaglutide group was significantly greater than that in the control group. Weight loss can reduce cardiac load, improve insulin resistance, and alleviate chronic low-grade inflammation, all of which are conducive to maintaining the stability of coronary artery lesions and reducing the occurrence of revascularization events. Second, semaglutide can improve vascular endothelial function [ 16 ]. Studies have confirmed that GLP-1 RAs can promote the production of endothelial nitric oxide, inhibit oxidative stress and inflammatory responses, and enhance endothelial barrier function. The improvement of endothelial function helps reduce the risk of plaque instability and thrombosis, thereby maintaining coronary artery patency and decreasing the need for revascularization [ 17 ]. Third, semaglutide exerts a lipid-lowering effect. The results of this study indicated that at the 6-month follow-up, semaglutide significantly reduced the levels of LDL-c, TC, and TG in patients, with its lipid-lowering effect being significantly superior to that of the control group. Elevated LDL-c is a core driver of the progression of coronary atherosclerosis and in-stent restenosis. The marked reduction of LDL-c by semaglutide may slow down the progression of residual coronary lesions and reduce the risk of in-stent restenosis, thus decreasing the requirement for unplanned revascularization. The absence of significant differences in the risk of severe adverse events such as cardiac death and recurrent myocardial infarction between the two groups may be related to the relatively short follow-up duration and small sample size of this study. The risk differences in such severe adverse events may require a longer follow-up period and a larger sample size to achieve statistical significance. C-TnI is a specific biomarker of myocardial injury, and its level and decline rate are closely correlated with the degree of myocardial damage and prognosis in ACS patients. Another important finding of this study is that compared with the control group, semaglutide can accelerate the improvement rate of cTnI levels during hospitalization, suggesting that this drug may alleviate myocardial injury in ACS patients. This potential cardioprotective effect may be mediated by multiple mechanisms: studies have reported that GLP-1 RAs can inhibit cardiomyocyte apoptosis, reduce myocardial ischemia-reperfusion injury, and regulate myocardial energy metabolism [ 18 ]. In addition, the anti-inflammatory and antioxidant effects of semaglutide may also mitigate myocardial inflammatory responses and oxidative stress damage, thereby alleviating myocardial injury [ 19 ]. Meanwhile, this study showed that semaglutide can significantly improve LVEF in non-diabetic obese patients with ACS, with the improvement amplitude being superior to that of the control group. LVEF is an important indicator for evaluating cardiac systolic function, and its improvement is crucial for reducing the incidence of heart failure and improving long-term prognosis. The improvement of LVEF by semaglutide may be associated with reduced cardiac load induced by weight loss, improved myocardial metabolism, and inhibited myocardial remodeling. The above findings suggest that semaglutide can not only improve the short-term prognosis of non-diabetic obese patients with ACS by reducing revascularization events, but also bring potential long-term benefits by protecting myocardial function [ 20 , 21 ]. In addition, the reduction amplitude of FBG by semaglutide was significantly superior to that of the control group. Although these patients do not meet the diagnostic criteria for diabetes, they may have an underlying state of insulin resistance, which is an important link between obesity and cardiovascular diseases. Semaglutide can improve insulin sensitivity by mimicking the action of GLP-1, thereby reducing blood glucose levels [ 5 ]. The improvement of glucose metabolism may further promote the stability of coronary artery lesions and reduce the occurrence of cardiovascular events. Furthermore, the significant weight-loss effect of semaglutide observed in this study is consistent with the results of the STEP series of studies [ 7 – 9 ]. Limitations Our results should be interpreted in view of some limitations: 1) as a retrospective cohort study, it inherently has the defect of being susceptible to selection bias and confounding factors. Although PSM was used to balance the baseline characteristics of the two groups, there may still be some unmeasurable confounding factors affecting the results. 2) the relatively short follow-up period limits the evaluation of the long-term efficacy and safety of semaglutide in this population. Future prospective studies with longer follow-up periods are needed to confirm the long-term prognostic benefits of semaglutide. 3) the relatively small sample size of this study may affect the statistical power of the research. Conclusions In conclusion, for non-diabetic obese ACS patients undergoing PCI, semaglutide treatment can significantly reduce their 6-month MACE and unplanned revascularization. In addition, semaglutide can accelerate the decline in cTnI levels, improve various metabolic indicators and enhance cardiac function. Therefore, semaglutide is expected to become a potential therapeutic option for improving the prognosis of non-diabetic obese ACS patients. Declarations Acknowledgments We acknowledge all the team members for their dedicated efforts in this experiment. Funding This study was supported by the Medical and Health Technology Project of Hangzhou (grant.A20241444）. Availability of data and materials The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. Author contributions Conceptualization: CL-J, L-H, YY-W, and LL-F; methodology: CL-J, J-W, B-Z, and YS-X,; software, J-W,; validation; CL-J, L-H, YY-W, and LL-F; formal analysis, B-Z, and YS-X,; investigation, L-H, YY-W, and LL-F; resources, CL-J, J-W, and LL-F; data curation, L-H, YY-W, J-W, B-Z, and YS-X; writing—original draft preparation, CL-J, and J-W,; writing—review and editing, CL-J, B-Z, YS-X, and LL-F; visualization, CL-J, and LL-F; supervision, CL-J, L-H, YY-W, and LL-F; project administration, CL-J. All authors have read and agreed to the published version of the manuscript. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conict of interest. Consent for publication Informed consent given by the patients enrolled in the current study was obtained at the time of surgery. Ethics statement and consent to participate This study protocol was approved by the Ethics Committee of The Hangzhou Tenth People's Hospital (Approval No.: K 2021-12), and conducted in accordance with the Declaration of Helsinki. Clinical trial registration This was a retrospective study, so clinical trial registration was not applicable. References Calabrò P, Moscarella E, Gragnano F, Cesaro A, Pafundi PC, Patti G, et al. Effect of Body Mass Index on Ischemic and Bleeding Events in Patients Presenting With Acute Coronary Syndromes (from the START-ANTIPLATELET Registry). Am J Cardiol. 2019;124(11):1662–8. Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham heart study. Circulation. 1983;67:968–77. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration (BMI Mediated Effects), Lu Y, Hajifathalian K, Ezzati M, Woodward M, Rimm EB, et al. metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1⋅8 million participants. Lancet. 2014;383:970–83. Cholesterol Treatment Trialists’ (CTT), Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–81. Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023;389(24):2221–32. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375(19):1834–44. Wilding JPH, Batterham RL, Davies M, Van-Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–64. Rubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414–25. Rubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, Sørrig R, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138–50. Kosiborod MN, Abildstrøm SZ, Borlaug BA, Butler J, Rasmussen S, Davies M, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389(12):1069–84. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231–64. GBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K et al. GBD 2015 obesity collaborators, health effects of overweight and obesity in 195 countries over 25 years, N. Engl. J. Med. 377 (2017) 13–27. Sharma KK, Mathur M, Lodha S, Sharma SK, Sharma N et al. Study of differences in presentation, risk factors and management in diabetic and nondiabetic patients with acute coronary syndrome. Indian J Endocrinol Metab 2016 May-Jun;20(3):354–8. Yaow CYL, Chong B, Chin YH, Kueh MTW, Ng CH, Chan KE, et al. Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews. Eur J Prev Cardiol. 2023;30(12):1227–35. De-Sio V, Gragnano F, Capolongo A, Guarnaccia N, Maddaluna P, Acerbo V, et al. Eligibility for and practical implications of Semaglutide in overweight and obese patients with acute coronary syndrome. Int J Cardiol. 2025;423:133028. Hullon D, Subeh GK, Volkova Y, Janiec K, Trach A, Mnevets R. The role of glucagon-like peptide-1 receptor (GLP-1R) agonists in enhancing endothelial function: a potential avenue for improving heart failure with preserved ejection fraction (HFpEF). Cardiovasc Diabetol. 2025;24(1):70. Almutairi M, Al-Batran R, Ussher JR. Glucagon-like peptide-1 receptor action in the vasculature. Peptides. 2019;111:26–32. Zhu Q, Luo Y, Wen Y, Wang D, Li J, Fan Z. Semaglutide inhibits ischemia/ reperfusion-induced cardiomyocyte apoptosis through activating PKG/PKCε/ERK1/2 pathway. Biochem Biophys Res Commun. 2023;647:1–8. Lin K, Wang A, Zhai C, Zhao Y, Hu H, Huang D, et al. Semaglutide protects against diabetes-associated cardiac inflammation via Sirt3-dependent RKIP pathway. Br J Pharmacol. 2025;182(7):1561–81. Kosiborod MN, Abildstrøm SZ, Borlaug BA, Butler J, Christensen L, Davies M, et al. Design and Baseline Characteristics of STEP-HFpEF Program Evaluating Semaglutide in Patients With Obesity HFpEF Phenotype. JACC Heart Fail. 2023;11(8 Pt 1):1000–10. Butler J, Abildstrøm SZ, Borlaug BA, Davies MJ, Kitzman DW, Petrie MC, et al. Semaglutide in Patients With Obesity and Heart Failure Across Mildly Reduced or Preserved Ejection Fraction. J Am Coll Cardiol. 2023;82(22):2087–96. Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Huang","suffix":""},{"id":622225396,"identity":"839f210d-f3d6-439d-8a24-b9dd4fc09504","order_by":2,"name":"Ying-ying Wei","email":"","orcid":"","institution":"Hangzhou Ninth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ying-ying","middleName":"","lastName":"Wei","suffix":""},{"id":622225403,"identity":"cda3499a-7911-4e0a-86ed-df0f7659ac41","order_by":3,"name":"Yun-shu Xu","email":"","orcid":"","institution":"Hangzhou Ninth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yun-shu","middleName":"","lastName":"Xu","suffix":""},{"id":622225413,"identity":"bdc351a3-835b-4513-baeb-8e37307ef1d7","order_by":4,"name":"Bo Zhang","email":"","orcid":"","institution":"Hangzhou Ninth People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Zhang","suffix":""},{"id":622225414,"identity":"71686d52-a56e-4343-9adb-ae8a0ca6b23c","order_by":5,"name":"Jing Wu","email":"","orcid":"","institution":"Affiliated Hangzhou First People's Hospital, Westlake University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Wu","suffix":""},{"id":622225418,"identity":"a0ebe7ea-6e6f-4666-b10b-932b4c839520","order_by":6,"name":"Ling-long Fan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBACAwkG9h8MDDYgBojLwMDH3tj48AN+LWxAKk0CqsWAgY3ncLOxBGEth6FagNawSaS3CfAQ0vJzx+E6c+nmw58LCv7Is0k+bGOQYLCT023A7ZeHvWfSJSznHEuTnmFgYNgmndj2oIAh2djsAB5beNusJQxu5Jgx8xgYMAK1tANFDyRuw6OF8W8bM0iL8WegFvs2yYNtEjwEtDDztjmDtBhIA7UktkkwEqFFti1NcsONNJBfjJPbeBKBgWyA2y/28w+wMb5ts+E3uJEMDLE/crb97McfPvxQYSeHSwsDAz8ippmRbMelHA0wE1YyCkbBKBgFIxEAALfAUSuG3RfuAAAAAElFTkSuQmCC","orcid":"","institution":"Hangzhou Ninth People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ling-long","middleName":"","lastName":"Fan","suffix":""}],"badges":[],"createdAt":"2026-03-18 16:25:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9161583/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9161583/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107254806,"identity":"bf577622-f8eb-4c80-82d6-cffb8b6dfab1","added_by":"auto","created_at":"2026-04-19 12:05:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":398264,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9161583/v1/7162f55d86b376d2ec419d9f.jpg"},{"id":107254807,"identity":"b132bed6-5d47-41ce-8e9c-59cc7b301032","added_by":"auto","created_at":"2026-04-19 12:05:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":540865,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure12.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9161583/v1/389e973d57d9ca2e1c0311fc.jpg"},{"id":107254808,"identity":"b9bfc40f-cda9-44f4-9391-d81b152f7bc6","added_by":"auto","created_at":"2026-04-19 12:05:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":311755,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Figure13.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9161583/v1/f4f3ff16d77bd1e145aa5f5c.jpg"},{"id":107484392,"identity":"044a16a4-a805-4a3b-bb47-a469027a7682","added_by":"auto","created_at":"2026-04-22 02:31:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1840991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9161583/v1/a1202b69-90b9-42af-aabd-4e49f12ce72e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Semaglutide in Non-diabetic Obese East Asian Patients with Acute Coronary Syndrome: A Multicenter Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe global prevalence of obesity continues to rise, according to statistics from the World Health Organization (WHO), the proportion of obese people worldwide exceeded 18% in 2025 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. As an independent risk factor for cardiovascular diseases, obesity can significantly increase the incidence of acute coronary syndrome (ACS) and the probability of adverse prognosis by inducing insulin resistance, inflammatory responses, endothelial dysfunction, and the progression of coronary atherosclerosis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Clinical data indicate that compared with ACS patients with normal weight, obese ACS patients without diabetes have a 42% higher incidence of heart failure during hospitalization, a 35% higher 30-day readmission rate, and a 28% higher 1-year all-cause mortality rate [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], making this a pressing clinical challenge to be addressed in the field of cardiology.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSemaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), was initially used for glycemic control in patients with type 2 diabetes mellitus (T2DM) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Later, it was approved for obesity management due to its proven weight-loss effect and evidence of cardiovascular protection[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The SUSTAIN-6 study confirmed that semaglutide can reduce the risk of major adverse cardiovascular events (MACE) by 26% in T2DM patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Subsequent STEP trials further demonstrated that it can achieve a 15%\u0026ndash;18% body weight reduction in non-diabetic obese populations, along with improvements in metabolic indicators such as blood pressure and blood lipids [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, current clinical evidence regarding semaglutide in obese ACS patients without diabetes remains limited, and there is no clear conclusion on whether semaglutide can reduce the risk of adverse prognosis through mechanisms such as weight loss, anti-inflammation, and improvement of myocardial remodeling.\u003c/p\u003e \u003cp\u003eBased on this, this study retrospectively analyzed the clinical data of obese ACS patients without diabetes, compared the prognostic differences between those treated with semaglutide and those without semaglutide treatment, aiming to provide real-world evidence for the drug intervention strategies in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis was a multi-center retrospective cohort study. The participants were obese patients without diabetes who were diagnosed with ACS and underwent percutaneous coronary intervention (PCI) during hospitalization in the department of cardiology at three hospitals (Hangzhou Ninth People's Hospital, Hangzhou Geriatric Hospital, Hangzhou Tenth People's Hospital) in China between May 2020 and December 2024.\u003c/p\u003e \u003cp\u003e(1) Inclusion Criteria: 1) Body mass index (BMI)\u0026thinsp;\u0026ge;\u0026thinsp;28 kg/m\u0026sup2;; 2) Patients meeting the diagnostic criteria for ACS, which included: Typical chest pain symptoms; Cardiac troponin I (cTnI) levels exceeding the 99th percentile of the upper reference limit; Electrocardiogram (ECG) showing ST-segment elevation or dynamic changes, or coronary angiography demonstrating coronary artery occlusion or severe stenosis (\u0026ge;\u0026thinsp;70%). (2) Exclusion Criteria: 1) Complicated with type 1 diabetes mellitus (T1DM), T2DM or gestational diabetes mellitus; Severe hepatic or renal insufficiency; 2)Personal or family history of medullary thyroid carcinoma contraindication to semaglutide administration); 3) A history of severe gastrointestinal diseases (e.g., intractable nausea and vomiting, gastroparesis); 4) Follow-up duration of less than 6 months or incomplete follow-up data. This is a retrospective study; therefore, no clinical trial registration was performed.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eGrouping method\u003c/h3\u003e\n\u003cp\u003eSemaglutide group: Patients received subcutaneous injection of semaglutide injection (1.34 mg/mL) starting on the first day after PCI. The dosage regimen was as follows: 0.25 mg once weekly for weeks 1\u0026ndash;4 (titration phase); 1.0 mg once weekly for weeks 5\u0026ndash;52. Control group: Patients did not receive semaglutide injection.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint of this study was the occurrence of MACE within 6 months after PCI. MACE was defined as a composite endpoint consisting of cardiac death, non-fatal recurrent acute myocardial infarction (AMI, confirmed by AMI diagnostic criteria), unplanned revascularization, and readmission due to heart failure (HF). The secondary endpoints included: 1) The dynamic changes in cTnI levels during hospitalization; 2) Changes in fasting blood glucose (FBG), glycated hemoglobin (HbA1c), BMI, lipid profiles and left ventricular ejection fraction (LVEF) at the 6-month follow-up; The diagnosis of AMI was made in accordance with the guidelines specified in the Fourth Universal Definition of MI [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The diagnostic criteria for obesity were defined as a BMI\u0026thinsp;\u0026ge;\u0026thinsp;28 kg/m\u0026sup2;. The definition of non-diabetic status was: FBG\u0026thinsp;\u0026lt;\u0026thinsp;7.0 mmol/L on admission, HbA1c\u0026thinsp;\u0026lt;\u0026thinsp;6.5%, no prior history of T2DM or T1DM, and no history of hypoglycemic agent administration. Cardiac death was defined as death attributable to a definite cardiac cause, unwitnessed death, or death of unknown etiology. The diagnosis of ischemia-driven target lesion revascularization (iTLR) and confirmed/suspected stent thrombosis at the 6-month follow-up was determined in accordance with the Academic Research Consortium (ARC) criteria.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected from the hospital electronic medical record (EMR) system and follow-up management platform, including the following patient information: 1) Baseline characteristics: age, gender, BMI, history of smoking, drinking, hypertension, coronary heart disease(CHD); 2) Laboratory parameters: FBG, HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), cTnI; 3) ACS subtype:(unstable angina[UA], ST segment elevation myocardial infarction [STEMI], non-ST-elevation myocardial infarction [NSTEMI]); 4) Culprit vessel; Concomitant medications (aspirin, clopidogrel/ticagrelor, statins, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers[ACEI/ARB], mineralocorticoid receptor antagonists).\u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eThe dynamic changes in cTnI levels were monitored during hospitalization. Telephone follow-up was conducted at 1 month and 3 months after discharge, and outpatient follow-up was performed at 6 months. Changes in HbA1c, FBG, LVEF, blood lipid profiles and BMI were recorded, and the occurrence of endpoint events was confirmed.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared using the Student's t-test. Categorical variables were expressed as frequencies and percentages and compared using the chi-squared test or Fisher's exact test. To minimize potential bias, propensity score matching (PSM) was performed at a 1:1 ratio between the semaglutide group and the control group. All statistical tests were two-tailed, and a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Statistical analyses were performed using IBM SPSS Statistics version 29.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eA total of 344 patients were enrolled in this study and completed 6 months of follow-up. Among them, 112 patients (32.6%) received semaglutide treatment post-PCI, while 232 patients (67.4%) did not receive semaglutide treatment. Patients in the semaglutide group exhibited the following characteristics: older age, higher proportion of males, higher BMI, lower HbA1c and FBG, higher LDL-C, lower LVEF; meanwhile, the proportion of patients with NSTEMI was higher in the semaglutide group. No significant differences were observed between the two groups in terms of perioperative procedures and medication regimens. After PSM, baseline and procedural characteristics were well balanced between two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Details of procedural characteristics and outcomes are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline clinical characteristics in the Semaglutide and control groups before and after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003ePropensity-matched patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemaglutide (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;232)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSemaglutide (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.723\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.5\u0026thinsp;\u0026plusmn;\u0026thinsp;12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/m2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of ACS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132(56.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59(52.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNSTEMI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSTEMI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCulprit vessel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLMCA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38(33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41(36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCX, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26(23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRCA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLipids, mg/L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of CVD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.0 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.0 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStroke, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30(27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (25.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.0 (17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.0 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.099\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.0 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.0 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.0 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.0 (16.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedications at discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspirin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107(95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e221(95.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e107(95.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e106(94.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClopidogrel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85(76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e183(78.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85(76.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86(76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTicagrelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26(23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25(22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eβ-blockers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81(72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151(65.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.2195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81(72.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5596\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACEI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63(56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128(55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63(56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eARB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19(17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17(15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.8559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110(98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e226(97.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110(98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e111(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: Values are n (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e \u003cp\u003eBMI: Body Mass Index;ACS: Acute coronary syndrome; UA༚Unstable angina༛NSTEMI༚Non-ST-segment elevation myocardial infarction༛STEMI༚ST-segment elevation myocardial infarction; FBG༚Fasting blood glucose༛CVD: Cardiovascular disease; CHD: Coronary heart disease; TC:Total cholesterol; TG:Triglycerides༛LMCA༚left main coronary artery; LAD:left anterior descending artery; LCX:left circumflex artery; LVEF:Left Ventricular Ejection Fraction; HDL-c: High-density lipoprotein cholesterol; LDL-c:Low-density lipoprotein cholesterol; ACEI: Angiotensin-converting enzyme inhibitors; ARB: Angiotensin receptor blockers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAngiographic and procedural results in the Semaglutide and control groups before and after propensity score matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003ePropensity-matched patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemaglutide (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;232)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSemaglutide (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCulprit vessel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLMCA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17(7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.829\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38(33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38(33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41(36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCX, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26(23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRCA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65(28.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStents per patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of stent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: Values are n (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e \u003cp\u003eBMI: Body Mass Index;ACS: Acute coronary syndrome; UA༚Unstable angina༛NSTEMI༚Non-ST-segment elevation myocardial infarction༛STEMI༚ST-segment elevation myocardial infarction; FBG༚Fasting blood glucose༛CVD: Cardiovascular disease; CHD: Coronary heart disease; TC:Total cholesterol; TG:Triglycerides༛LMCA༚left main coronary artery; LAD:left anterior descending artery; LCX:left circumflex artery; LVEF:Left Ventricular Ejection Fraction; HDL-c: High-density lipoprotein cholesterol; LDL-c:Low-density lipoprotein cholesterol.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003ePrimary endpoint\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eBefore PSM, compared with the control group, patients treated with semaglutide had a significantly lower incidence of MACE at 6 months (11.6% vs. 21.1%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036 ). The proportion of unplanned revascularization in semaglutide-treated patients was significantly lower than that in the control group (4.7% vs. 7.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045), whereas no significant differences were noted between the two groups in cardiac death (1.8% vs. 1.7%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.236), non-fatal recurrent AMI (1.8% vs. 3.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.067), and HF hospitalization (3.6% vs. 8.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.9999) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;1A-E). After PSM, the 6-month MACE incidence in the semaglutide group remained significantly lower than that in the control group (11.6% vs. 23.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034). This difference was mainly attributed to the markedly lower incidence of unplanned revascularization in the semaglutide group compared with the control group (4.7% vs. 13.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033). No significant differences were detected between the two groups in cardiac death (1.8% vs. 3.6%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.9999), non-fatal recurrent AMI (1.8% vs. 3.6%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.683), and HF hospitalization (3.6% vs. 5.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.9999) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;1F-J).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical outcomes in the semaglutide and control groups before and after propensity score matching.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAll patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003ePropensity-matched patients\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemaglutide (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;232)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSemaglutide (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;112)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMACE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49(21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26(23.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac death, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRevascularization, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(4.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(13.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHF hospitalization, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(3.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.9999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote: Values are n (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e \u003cp\u003eMACE:Major Adverse Cardiovascular Events; MI:myocardial infarction; HF:heart failure.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSecondary endpoint\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAnalysis of the dynamic changes in cTnI revealed that the decline rate of cTnI in the semaglutide group was significantly faster than that in the control group(Fig.\u0026nbsp;2). Follow-up assessments of metabolic indicators and cardiac function showed that in the control group, LDL-C (3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82mmol/L vs. 2.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, ), TC (5.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12mmol/L vs. 4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031), and TG (2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54mmol/L vs. 1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) decreased significantly, and LVEF was improved (53.13\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26% vs. 55.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.67%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.038) (Fig.\u0026nbsp;2). In the semaglutide group, significant reductions were observed in BMI (30.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69kg/m\u0026sup2;vs. 28.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 kg/m\u0026sup2;, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), HbA1c (5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59% vs. 5.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016), FBG (5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60mmol/L vs. 5.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), LDL-C (3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03mmol/L vs. 1.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), TC (5.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84mmol/L vs. 4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and TG (2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82mmol/L vs. 1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), along with a marked improvement in LVEF (49.93\u0026thinsp;\u0026plusmn;\u0026thinsp;8.11% vs. 54.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Fig.\u0026nbsp;2). Additionally, we found that the improvement magnitudes of BMI (2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27 kg/m\u0026sup2;vs. 0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76 kg/m\u0026sup2;, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), FBG (0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75mmol/L vs. 0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), LDL-c(1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22mmol/L vs. 0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), TG(0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02mmol/L vs. 0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and LVEF (5.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07% vs. 2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.09%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005) (Fig.\u0026nbsp;3) in the semaglutide group were significantly superior to those in the control group.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicenter retrospective cohort study aimed to explore the prognostic value of semaglutide in non-diabetic obese patients with ACS who underwent PCI. The key findings demonstrated that compared with the control group, semaglutide treatment significantly reduced the incidence of 6-month MACE and unplanned revascularization both before and after PSM. In addition, semaglutide accelerated the decline rate of cTnI during hospitalization, and its efficacy in improving metabolic indicators and LVEF was significantly superior to that of the control group.\u003c/p\u003e \u003cp\u003eAs a well-recognized independent risk factor for CHD, obesity exacerbates the pathological progression of ACS through multiple pathways including insulin resistance, chronic inflammation, and endothelial dysfunction, thereby increasing the risk of adverse prognosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous clinical studies have confirmed that non-diabetic obese patients with ACS have significantly higher in-hospital heart failure incidence, readmission rate, and long-term mortality, which poses a severe challenge to clinical treatment [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As a GLP-1 RA, semaglutide\u0026rsquo;s weight-loss and cardioprotective effects have been extensively validated in patients with T2DM and non-diabetic obese populations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, previous relevant evidence has mostly focused on non-ACS populations, and the role of semaglutide in non-diabetic obese patients with ACS remains unclear. The present study found that semaglutide treatment significantly reduced the 6-month MACE incidence in this specific population, which is consistent with the cardioprotective effects observed in previous studies, suggesting that the cardioprotective potential of semaglutide may be extended to non-diabetic obese patients with ACS.\u003c/p\u003e \u003cp\u003eNotably, the significant reduction in MACE and unplanned revascularization in the semaglutide group was observed in this study, whereas there were no significant differences between the two groups in the incidence of other endpoint events such as cardiac death, recurrent myocardial infarction, and heart failure readmission. This finding may be associated with the following mechanisms: First, the indirect effect of semaglutide\u0026rsquo;s weight-loss property [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The study showed that the reduction amplitude of BMI in the semaglutide group was significantly greater than that in the control group. Weight loss can reduce cardiac load, improve insulin resistance, and alleviate chronic low-grade inflammation, all of which are conducive to maintaining the stability of coronary artery lesions and reducing the occurrence of revascularization events. Second, semaglutide can improve vascular endothelial function [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies have confirmed that GLP-1 RAs can promote the production of endothelial nitric oxide, inhibit oxidative stress and inflammatory responses, and enhance endothelial barrier function. The improvement of endothelial function helps reduce the risk of plaque instability and thrombosis, thereby maintaining coronary artery patency and decreasing the need for revascularization [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Third, semaglutide exerts a lipid-lowering effect. The results of this study indicated that at the 6-month follow-up, semaglutide significantly reduced the levels of LDL-c, TC, and TG in patients, with its lipid-lowering effect being significantly superior to that of the control group. Elevated LDL-c is a core driver of the progression of coronary atherosclerosis and in-stent restenosis. The marked reduction of LDL-c by semaglutide may slow down the progression of residual coronary lesions and reduce the risk of in-stent restenosis, thus decreasing the requirement for unplanned revascularization. The absence of significant differences in the risk of severe adverse events such as cardiac death and recurrent myocardial infarction between the two groups may be related to the relatively short follow-up duration and small sample size of this study. The risk differences in such severe adverse events may require a longer follow-up period and a larger sample size to achieve statistical significance.\u003c/p\u003e \u003cp\u003eC-TnI is a specific biomarker of myocardial injury, and its level and decline rate are closely correlated with the degree of myocardial damage and prognosis in ACS patients. Another important finding of this study is that compared with the control group, semaglutide can accelerate the improvement rate of cTnI levels during hospitalization, suggesting that this drug may alleviate myocardial injury in ACS patients. This potential cardioprotective effect may be mediated by multiple mechanisms: studies have reported that GLP-1 RAs can inhibit cardiomyocyte apoptosis, reduce myocardial ischemia-reperfusion injury, and regulate myocardial energy metabolism [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In addition, the anti-inflammatory and antioxidant effects of semaglutide may also mitigate myocardial inflammatory responses and oxidative stress damage, thereby alleviating myocardial injury [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMeanwhile, this study showed that semaglutide can significantly improve LVEF in non-diabetic obese patients with ACS, with the improvement amplitude being superior to that of the control group. LVEF is an important indicator for evaluating cardiac systolic function, and its improvement is crucial for reducing the incidence of heart failure and improving long-term prognosis. The improvement of LVEF by semaglutide may be associated with reduced cardiac load induced by weight loss, improved myocardial metabolism, and inhibited myocardial remodeling. The above findings suggest that semaglutide can not only improve the short-term prognosis of non-diabetic obese patients with ACS by reducing revascularization events, but also bring potential long-term benefits by protecting myocardial function [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In addition, the reduction amplitude of FBG by semaglutide was significantly superior to that of the control group. Although these patients do not meet the diagnostic criteria for diabetes, they may have an underlying state of insulin resistance, which is an important link between obesity and cardiovascular diseases. Semaglutide can improve insulin sensitivity by mimicking the action of GLP-1, thereby reducing blood glucose levels [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The improvement of glucose metabolism may further promote the stability of coronary artery lesions and reduce the occurrence of cardiovascular events. Furthermore, the significant weight-loss effect of semaglutide observed in this study is consistent with the results of the STEP series of studies [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur results should be interpreted in view of some limitations: 1) as a retrospective cohort study, it inherently has the defect of being susceptible to selection bias and confounding factors. Although PSM was used to balance the baseline characteristics of the two groups, there may still be some unmeasurable confounding factors affecting the results. 2) the relatively short follow-up period limits the evaluation of the long-term efficacy and safety of semaglutide in this population. Future prospective studies with longer follow-up periods are needed to confirm the long-term prognostic benefits of semaglutide. 3) the relatively small sample size of this study may affect the statistical power of the research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, for non-diabetic obese ACS patients undergoing PCI, semaglutide treatment can significantly reduce their 6-month MACE and unplanned revascularization. In addition, semaglutide can accelerate the decline in cTnI levels, improve various metabolic indicators and enhance cardiac function. Therefore, semaglutide is expected to become a potential therapeutic option for improving the prognosis of non-diabetic obese ACS patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge all the team members for their dedicated efforts in this experiment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Medical and Health Technology Project of Hangzhou (grant.A20241444）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: CL-J, L-H, YY-W, and LL-F; methodology: \u0026nbsp; CL-J, J-W, B-Z, and YS-X,; software, J-W,; validation; CL-J, L-H, YY-W, and LL-F; formal analysis, B-Z, and YS-X,; investigation, L-H, YY-W, and LL-F; resources, CL-J, J-W, and LL-F; data curation, L-H, YY-W, J-W, B-Z, and YS-X; writing—original draft preparation, CL-J, and J-W,; writing—review and editing, CL-J, B-Z, YS-X, and LL-F; visualization, CL-J, and LL-F; supervision, CL-J, L-H, YY-W, and LL-F; project administration, CL-J. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent given by the patients enrolled in the current study was obtained at the time of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics statement and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study protocol was approved by the Ethics Committee of The Hangzhou Tenth People's Hospital (Approval No.: K 2021-12), and conducted in accordance with the\u003c/p\u003e\n\u003cp\u003eDeclaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a retrospective study, so clinical trial registration was not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCalabr\u0026ograve; P, Moscarella E, Gragnano F, Cesaro A, Pafundi PC, Patti G, et al. 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N Engl J Med. 2016;375(19):1834\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilding JPH, Batterham RL, Davies M, Van-Gaal LF, Kandler K, Konakli K, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubino D, Abrahamsson N, Davies M, Hesse D, Greenway FL, Jensen C, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubino DM, Greenway FL, Khalid U, O'Neil PM, Rosenstock J, S\u0026oslash;rrig R, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosiborod MN, Abildstr\u0026oslash;m SZ, Borlaug BA, Butler J, Rasmussen S, Davies M, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389(12):1069\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2015 Obesity Collaborators, Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K et al. GBD 2015 obesity collaborators, health effects of overweight and obesity in 195 countries over 25 years, N. Engl. J. Med. 377 (2017) 13\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma KK, Mathur M, Lodha S, Sharma SK, Sharma N et al. Study of differences in presentation, risk factors and management in diabetic and nondiabetic patients with acute coronary syndrome. Indian J Endocrinol Metab 2016 May-Jun;20(3):354\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYaow CYL, Chong B, Chin YH, Kueh MTW, Ng CH, Chan KE, et al. Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes Mellitus: an Umbrella review of systematic reviews. Eur J Prev Cardiol. 2023;30(12):1227\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe-Sio V, Gragnano F, Capolongo A, Guarnaccia N, Maddaluna P, Acerbo V, et al. Eligibility for and practical implications of Semaglutide in overweight and obese patients with acute coronary syndrome. Int J Cardiol. 2025;423:133028.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHullon D, Subeh GK, Volkova Y, Janiec K, Trach A, Mnevets R. The role of glucagon-like peptide-1 receptor (GLP-1R) agonists in enhancing endothelial function: a potential avenue for improving heart failure with preserved ejection fraction (HFpEF). Cardiovasc Diabetol. 2025;24(1):70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmutairi M, Al-Batran R, Ussher JR. Glucagon-like peptide-1 receptor action in the vasculature. Peptides. 2019;111:26\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu Q, Luo Y, Wen Y, Wang D, Li J, Fan Z. Semaglutide inhibits ischemia/ reperfusion-induced cardiomyocyte apoptosis through activating PKG/PKCε/ERK1/2 pathway. Biochem Biophys Res Commun. 2023;647:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin K, Wang A, Zhai C, Zhao Y, Hu H, Huang D, et al. Semaglutide protects against diabetes-associated cardiac inflammation via Sirt3-dependent RKIP pathway. Br J Pharmacol. 2025;182(7):1561\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKosiborod MN, Abildstr\u0026oslash;m SZ, Borlaug BA, Butler J, Christensen L, Davies M, et al. Design and Baseline Characteristics of STEP-HFpEF Program Evaluating Semaglutide in Patients With Obesity HFpEF Phenotype. JACC Heart Fail. 2023;11(8 Pt 1):1000\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButler J, Abildstr\u0026oslash;m SZ, Borlaug BA, Davies MJ, Kitzman DW, Petrie MC, et al. Semaglutide in Patients With Obesity and Heart Failure Across Mildly Reduced or Preserved Ejection Fraction. J Am Coll Cardiol. 2023;82(22):2087\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Semaglutide, Non-diabetic, Obese, Acute Coronary Syndrome, Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-9161583/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9161583/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to assess clinical benefits of semaglutide for East Asian non-diabetic obese patients with ACS who have undergone percutaneous coronary intervention (PCI) .\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter PSM, the 6-month MACE (11.6% vs. 23.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.034) and unplanned revascularization (4.7% vs. 13.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033) in the semaglutide group were significantly lower than those in the control group, and the improvement in cTnI levels was faster in the semaglutide group. 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\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60mmol/L vs. 5.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43mmol/L, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), glycated hemoglobin (HbA1c) (5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59% vs. 5.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.016) and body mass index (BMI) (30.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69 kg/m\u0026sup2;vs. 28.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 kg/m\u0026sup2;, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Particularly, the magnitudes of improvements in BMI (2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27 kg/m\u0026sup2;vs. 0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76 kg/m\u0026sup2;, p\u0026thinsp;=\u0026thinsp;0.002), FBG (0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75mmol/L vs. 0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83mmol/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), LDL-c(1.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22mmol/L vs. 0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94mmol/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), TG(0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02mmol/L vs. 0.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70mmol/L, p\u0026thinsp;=\u0026thinsp;0.003) and LVEF (5.73\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07% vs. 2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;8.09%, p\u0026thinsp;=\u0026thinsp;0.005) in the semaglutide group were significantly superior to those in the control group.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e 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