Patients with diabetes who received GLP-1 receptor agonists after percutaneous coronary intervention (PCI) for acute myocardial infarction demonstrated significantly improved 3-year survival rates compared to those not receiving the medications, according to new research presented at the Society for Cardiovascular Angiography and Interventions Scientific Sessions.
The retrospective study, led by Moses Sghayyer, MD, an internal medicine resident at the University of Alabama at Birmingham, analyzed 1,552 patients with type 2 diabetes who underwent PCI for acute MI between 2015 and 2022. After propensity score matching, researchers compared 776 patients who used a GLP-1 after their procedure with 776 patients who did not, with a mean age of 64 years and 57% male representation. Approximately two-thirds of patients in both groups also had obesity.
Mortality Reduction Without Procedural Benefits
The primary outcome showed a 26% reduction in all-cause mortality at 3 years in the GLP-1 group (HR = 0.74; 95% CI, 0.6-0.92). However, there was no difference between groups in secondary outcomes of in-stent restenosis (HR = 1.28; 95% CI, 0.88-1.86) and revascularization (HR = 1.21; 95% CI, 0.91-1.6) at 3 years.
"The difference in mortality without a corresponding decrease in revascularization or in-stent restenosis suggests that the observed mortality benefit may be attributable to the broader cardiovascular protective effects of GLP-1s rather than a direct influence on PCI-specific outcomes," Sghayyer explained. "GLP-1s have demonstrated anti-inflammatory, anti-atherosclerotic and cardioprotective properties, which could explain the mortality reduction independently of procedural outcomes."
Growing Evidence for Cardiovascular Protection
The findings align with broader evidence supporting GLP-1 receptor agonists in cardiovascular care. At the ASPC 2025 Congress on CVD Prevention, experts highlighted the evolution of these medications and their expanding cardiovascular applications.
Vinita Aroda, MD, director of diabetes clinical research at Harvard Medical School, described the progression from early agents like Exenatide BID in 2005, which showed modest 2-pound weight loss and glucose control, to current dual-action medications like tirzepatide. "For the first time, we saw that more than 50% of people achieved an [hemoglobin] A1c less than 5.7," Aroda noted.
A 2024 meta-analysis demonstrated that GLP-1s reduced odds of major adverse cardiac events and all-cause mortality compared with placebo, with some recent studies showing separation occurring as early as 6 months after starting treatment, compared to the 12 years typically seen in earlier studies.
Clinical Trial Evidence and Guidelines Integration
Darren McGuire, MD, MHSc, distinguished teaching professor at University of Texas Southwestern Medical Center, emphasized that three injectable GLP-1 medications now carry FDA product label indications for cardiovascular protection and have achieved level 1a endorsement in both endocrinology and cardiology guidelines, including the 2023 European Society for Cardiology guidelines.
Recent trials have reinforced these benefits. The SOUL trial found that oral semaglutide reduced cardiovascular events compared with placebo and demonstrated reduced rates of hospitalization for acute and chronic limb ischemia. The SURPASS trial showed tirzepetide was non-inferior to dulaglutide for 3-point major adverse cardiovascular events, with all-cause mortality 16% lower in the tirzepatide group.
The SUMMIT trial demonstrated that tirzepatide decreased the cumulative incidence of death from cardiovascular causes or worsening heart-failure events compared with placebo over 136 weeks, with outcome separation beginning as early as 24 weeks.
Clinical Implementation Recommendations
Despite the evidence, McGuire noted that most cardiology clinics in the US are prescribing these medications in single digits. "These have to become part of our usual arsenal. We have guidelines and professional society endorsements. These should immediately impact care, not just in the endocrinology clinics and not just in primary care, but in the cardiology clinic," he stated.
For patient counseling, Aroda recommended that clinicians emphasize goals of decreasing heart and kidney disease risk while optimizing long-term health. She stressed the importance of patient education about hydration and muscle resistance training, noting that "it isn't about getting to the highest dose fast enough or maximum efficacy. It's understanding the patient in front of you, educating, escalating to an appropriate dose, acknowledging the potential effects, and modifying to the patient."
Study Limitations and Future Directions
Sghayyer acknowledged that the retrospective nature of his study can demonstrate correlation but not causation, emphasizing the need for prospective, randomized trials and mechanistic studies to confirm the findings. "Physicians should consider the potential mortality benefits of GLP-1s when managing patients with type 2 diabetes after PCI for acute myocardial infarction," he recommended. "While GLP-1s may not reduce revascularization or in-stent restenosis, they could provide long-term survival benefits, reinforcing their use as part of comprehensive postinfarction care in diabetic patients."
The expanding applications of GLP-1s now include kidney disease, heart failure with preserved ejection fraction, and metabolic-associated liver disease, all of which can impact cardiovascular outcomes, further supporting their integration into cardiovascular care protocols.
