Association of GLP-1 Inhibitors with Cardiovascular Outcomes in Patients Undergoing Coronary Artery Bypass Surgery

OBJECTIVES: Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated cardiovascular benefit in patients with diabetes and obesity. Patients undergoing coronary artery bypass grafting (CABG) often have similar cardiovascular risk profiles. Therefore, this study sought to investigate the impact of preoperative GLP-1 use in patients undergoing CABG. METHODS: A retrospective review of a prospectively maintained cardiac surgery database was conducted. Patients undergoing a non-emergent isolated CABG from 2010-2024 were stratified by GLP-1 users and non-users. Multivariable Cox proportional hazards regression models were used to assess risk of all-cause mortality, major adverse cardiovascular and cerebral events (MACCE), and short-term 30-day mortality. Variables for multivariable adjustment were selected by variable importance of random forest models. RESULTS: A total of 11,389 patients underwent isolated CABG, of whom 4,170 had complete medication data. Among these, 165 (3.9%) patients were on GLP-1 inhibitors for a median of 353 days. GLP-1 users were younger, more likely to be women, diabetic, hypertensive and have a higher body mass index. GLP-1 users had a longer intensive care unit length of stay, although the overall length of stay was similar between the cohorts. In adjusted analysis, no significant difference in all-cause mortality or MACCE was found between groups. Notably, GLP-1 use was associated with a significantly lower incidence of new onset post-operative atrial fibrillation (14% vs 22%, p=0.02). CONCLUSIONS: Preoperative GLP-1 use in CABG patients was not associated with an increased risk of mortality or MACCE. GLP-1 use was associated with reduced postoperative atrial fibrillation, which warrants further investigation of GLP-1's potential perioperative benefits in larger studies.