Early glucagon-like peptide-1 receptor agonist use after myocardial infarction in patients with type 2 diabetes

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