Nearly 75% of ACS patients were eligible for semaglutide, with 43% of them at high risk of death (HR 1.9 all-cause, HR 2.0 CV death) versus low-risk patients.
Can a decision tree algorithm identify patients eligible for semaglutide who are at highest risk of mortality after an acute coronary syndrome?
Among patients discharged after an ACS, nearly 75% are eligible for semaglutide based on recent guidelines, and a decision tree algorithm can identify the 43% at highest risk for mortality who might benefit most from targeted therapy.
Absolute Event Rate: 0% vs 0%
Abstract Background the 2023 guidelines for chronic coronary syndrome recommend treatment with semaglutide for the reduction of mortality and major adverse cardiovascular events in patients with body mass index (BMI) 27 kg/m2 without diabetes. We investigated if we could identify which of these patients are actually at higher risk of death or MACE after an acute coronary syndrome (ACS). Methods we performed a retrospective study with the 8,252 patients discharged after an ACS from 2 hospitals from Spain. Patients with BMI ≥27kg/m2 with or without diabetes were categorized as eligible; patients without diabetes and BMI 27 27kg/m2 were categorized as non-eligible. The identification of the subset at higher risk of all-cause or cardiovascular (CV) death was performed by a decision tree obtained with Chi-square automatic interaction detection (CHAID) algorithms. Results we included 8,252 patients, mean age 65.1 (13.2) years, 25.9% women, mean BMI 28.4 (16.5) kg/m2 and 37.2% discharged after a ST-elevation ACS (STEMI). Patients eligible for treatment with semaglutide represented 74.1% (n=6,114), most of them due to 89% for (BMI) 27 kg/m2 and 11% due to diabetes. Mean follow-up was 54.7 (32.6) months; all-cause mortality rate was 16.8% and 14.2% was CV death. Eligible patients had slightly but significantly lower mortality rates. The decision tree (figure 1) provided 11 clusters based on age, glomerular filtration rate (GFR), Killip-Kimball (KK) class, the GRACE score and STEMI presentation. Cluster 5 had the lowest mortality rates and was considered as the reference (figure 2A). Clusters had different mortality rates (figure 2A) and adjusted risk (figure 2B) for all-cause or cardiovascular death through the follow-up. We generated a high-risk group of eligible patients with clusters 2,3,4,7,8,10 and 11 that represented and classified the cohort in 3 group: non-eligible (33.0%; n=2,960), eligible low-risk (23.6%; n=2,126) and eligible at high risk (43.4%; n=3,894). Kaplan Myer curves showed statistically different mortality rates (log rank p0.01) between these 3 groups. Multivariate analyses, adjusted by age, sex, revascularization and medical treatments, showed that patients eligible at high-risk had higher risk of all-cause (HR: 1.9 95%CI 1.5-2.4 p0.01) and CV death (HR: 2.0 95% CI 1.5-2.7; p0.01). Non-eligible patients also had higher risk of all-cause (HR: 1.4 95% CI 1.2-1.9; p0.01) and CV mortality (HR: 1.4 95% CI 1.1-2.0; p=0.02) Conclusions nearly 75% of the patients discharged after an ACS are eligible for treatment with semaglutide anda decision tree algorithm defined that 43% are actually at higher risk of mortality.Decision tree Figure 2
Cordero et al. (Sat,) reported a other. Nearly 75% of ACS patients were eligible for semaglutide, with 43% of them at high risk of death (HR 1.9 all-cause, HR 2.0 CV death) versus low-risk patients.
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