塞马鲁肽治疗急性冠状动脉综合征患者与减肥手术患者住院后的临床结果:一项回顾性多中心分析

HCA healthcare journal of medicine Pub Date : 2025-06-01 eCollection Date: 2025-01-01 DOI:10.36518/2689-0216.1960
Nameer Ascandar, Charles Boadu, Gauthier Stepman, George Skaf, Olugbenga Oyesanmi, Sabry Omar, Rias Ali, Michael Schandorf-Lartey
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引用次数: 0

摘要

背景:肥胖是一种慢性疾病,在美国的患病率正在上升。许多发病率和死亡率都与肥胖有关,冠状动脉疾病是最常见的疾病之一。缺血性心脏病仍然是美国人死亡的主要原因。综上所述,将肥胖对心脏病风险患者的有害影响降至最低的干预措施不仅有利于患者,也有利于医疗保健系统。方法:在这项回顾性研究中,我们使用HCA医疗保健企业数据仓库来识别所有因急性冠脉综合征(ACS)入院的成人患者,这些患者目前或以前接受过西马鲁肽或减肥手术治疗。进行描述性和回归分析来检查我们感兴趣的主要和次要结局。结果:符合纳入标准的10316例患者中,西马鲁肽组6920例(67.1%),减肥手术组3396例(32.9%)。与减肥手术组相比,西马鲁肽组的患者平均年龄较大,多为男性,非白人,吸烟较少。回归分析结果显示,西马鲁肽组与较低的住院死亡率相关(AOR, 0.61;95% CI, 0.41-0.92)和更高的急性心力衰竭几率(AOR, 3.45;95% CI, 2.2-5.4)与减肥手术相比。此外,负二项回归显示,与肥胖组相比,西马鲁肽组因ACS住院后的住院时间缩短了1.5。西马鲁肽组患者通过经皮冠状动脉介入治疗实现血运重建术的几率较高(AOR, 1.19;95% CI, 1.04-1.35)与减肥手术组比较。最后,西马鲁肽组发生急性心力衰竭的几率更高(3.45;2.19-5.44),与减肥手术组比较。结论:与先前接受过减肥手术的患者相比,使用西马鲁肽与较低的住院死亡率和较短的住院时间相关,但急性心力衰竭的发生率较高。使用西马鲁肽与获得血运重建的几率较高相关。最后,西马鲁肽可能是预防缺血性心脏病风险肥胖患者主要不良事件的有效替代药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Outcomes After Hospitalization for Acute Coronary Syndrome in Patients Treated with Semaglutide Versus Bariatric Surgery: A Retrospective Multicenter Analysis.

Background: Obesity is a chronic medical condition with a rising prevalence in the United States. A wide range of morbidity and mortality is associated with obesity, with coronary artery disease being among the most common. Ischemic heart disease continues to be the primary cause of death in the United States. Taken together, interventions to minimize the detrimental effects of obesity on patients at risk of heart disease will not only benefit the patient, but the health care system as well.

Methods: In this retrospective study, we used the HCA Healthcare enterprise data warehouse to identify all adult patients who were admitted for acute coronary syndrome (ACS) and were currently or previously treated for obesity with either semaglutide or bariatric surgery. Descriptive and regression analysis were performed to examine our primary and secondary outcomes of interest.

Results: Of 10 316 total patients who met inclusion criteria, 6920 (67.1%) were in the semaglutide group and 3396 (32.9%) were in the bariatric surgery group. The semaglutide cohort was on average older, more frequently men, nonwhite race, and less frequently smokers compared with the bariatric surgery group. Results of regression analysis showed the semaglutide group was associated with lower odds of in-hospital mortality (AOR, 0.61; 95% CI, 0.41-0.92) and higher odds of acute heart failure (AOR, 3.45; 95% CI, 2.2-5.4) compared to bariatric surgery. Furthermore, negative binomial regression showed a 1.5 shorter duration of hospital stay for the semaglutide cohort following inpatient admission for ACS compared with the bariatric group. The semaglutide cohort was linked with higher odds of achieving revascularization via percutaneous coronary intervention (AOR, 1.19; 95% CI, 1.04-1.35) compared with the bariatric surgery group. Lastly, the semaglutide group was associated with higher odds of acute heart failure (3.45; 2.19-5.44) compared with the bariatric surgery group.

Conclusion: Semaglutide use was associated with lower in-hospital mortality and shorter duration of hospital stay but higher odds of acute heart failure compared with patients who had prior bariatric surgery. Semaglutide use was associated with higher odds of acquiring revascularization. Lastly, semaglutide may be an effective alternative to prevent major adverse events in obese patients at risk of ischemic heart disease.

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