More Than 1 in 4 Heart Attack Patients May Be Eligible for Semaglutide to Prevent Future Cardiac Events | Research

The takeaway

In a real-world registry of nearly 3,000 heart attack patients, 27.4% met the eligibility criteria used in the landmark SELECT trial for semaglutide — highlighting a large, underserved population that could benefit from the drug.

27.4% eligible
More than 1 in 4 real-world heart attack patients met the SELECT trial criteria for semaglutide — non-diabetic, overweight/obese, with prior cardiovascular disease

What the researchers found

Of 2,940 consecutive acute coronary syndrome patients in the START-ANTIPLATELET registry, 807 (27.4%) met the SELECT trial eligibility criteria for semaglutide at 60 days post-discharge: age ≥45, BMI ≥27, history of MI/stroke/peripheral artery disease, and no diabetes.

At one-year follow-up, the SELECT-eligible group had significantly lower rates of major adverse cardiovascular events (MACE: 4.6% vs. 8.2%, p=0.004) and net adverse clinical events (NACE: 3.6% vs. 7.6%, p<0.001) compared to ineligible patients. This paradoxically lower event rate in the eligible group suggests that the SELECT criteria may identify a population with a different risk profile than the broader ACS population.

Why it matters

Semaglutide's cardiovascular benefits in the SELECT trial were groundbreaking, but translating trial results into real-world practice requires knowing how many patients qualify. This study shows that over a quarter of heart attack patients could be candidates — a substantial number that could reshape secondary prevention strategies for cardiovascular disease.

How the study worked

This was a retrospective analysis of the multicenter START-ANTIPLATELET registry (NCT02219984), which enrolled consecutive ACS patients across Italian centers. Patients were stratified by SELECT trial eligibility criteria at 60 days post-ACS discharge. Outcomes (MACE and NACE composites) were compared between eligible and ineligible groups at 1-year follow-up.

What this study cannot tell us

This was an observational registry analysis, not a randomized trial, so the outcome differences between groups may reflect confounders rather than treatment effects. The study assessed eligibility only — patients were not actually treated with semaglutide. The registry was Italian, which may limit generalizability to other populations with different obesity and diabetes prevalence rates.

How to read the evidence

This is a retrospective observational registry study that assessed treatment eligibility rather than treatment outcomes. While it provides valuable real-world context for the SELECT trial, it does not generate new efficacy evidence for semaglutide itself.

When this study was published

Published in 2025, this study directly addresses the clinical implementation of semaglutide following the 2023 SELECT trial results — highly current and relevant.

The bigger picture

GLP-1 receptor agonists like semaglutide are expanding beyond diabetes into cardiovascular secondary prevention. This study helps quantify the real-world impact: if over a quarter of post-heart attack patients qualify, semaglutide could become a standard part of cardiac care alongside statins, antiplatelets, and beta-blockers — a major expansion of its clinical footprint.

Questions still open

Would semaglutide actually reduce events in these eligible post-ACS patients, given their already lower baseline event rates compared to the ineligible group?
How do real-world barriers like cost, insurance coverage, and patient willingness affect the practical uptake of semaglutide in this population?
Should the eligibility criteria for semaglutide in cardiovascular prevention be broadened beyond the SELECT trial criteria to include diabetic or normal-weight patients?

Common questions

What was the SELECT trial and why does it matter for heart attack patients?

SELECT was a landmark trial showing that semaglutide 2.4 mg weekly reduced cardiovascular events by 20% in overweight/obese non-diabetic patients with existing heart disease. This registry study asks how many real-world heart attack patients would qualify for the same treatment.

Why did the semaglutide-eligible group actually have better outcomes even without the drug?

The SELECT criteria exclude diabetic patients, who tend to have higher cardiovascular risk. By filtering out diabetes, the eligible group was inherently healthier in some ways. This raises an important question about whether semaglutide's benefit will be as large in this lower-risk subset as it was in the trial.

Read the original research

Eligibility for and practical implications of Semaglutide in overweight and obese patients with acute coronary syndrome.

International journal of cardiology, 423, 133028

View on PubMed ↗Publisher’s paper ↗

Citation

De Sio, Vincenzo; Gragnano, Felice; Capolongo, Antonio; Guarnaccia, Natale; Maddaluna, Pasquale; Acerbo, Vincenzo; Galli, Mattia; Berteotti, Martina; Sperlongano, Simona; Cesaro, Arturo; Moscarella, Elisabetta; Pelliccia, Francesco; Patti, Giuseppe; Antonucci, Emilia; Cirillo, Plinio; Pignatelli, Pasquale; Palareti, Gualtiero; Pengo, Vittorio; Gresele, Paolo; Marcucci, Rossella; Calabrò, Paolo. (2025). Eligibility for and practical implications of Semaglutide in overweight and obese patients with acute coronary syndrome.. International journal of cardiology, 423, 133028. https://doi.org/10.1016/j.ijcard.2025.133028