Semaglutide Improves CV Outcomes in Patients with Prior Coronary Artery Bypass Surgery: Insights from the SELECT Trial

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By Joseph Kim on

Key Takeaways:

  1. In this secondary analysis of the SELECT Trial, semaglutide 2.4 mg once weekly significantly reduced the risk of major adverse cardiovascular events (MACE) in patients with or without a history of coronary artery bypass grafting (CABG), with a greater absolute risk reduction observed in the CABG group (2.3% vs. 1.0%).
  2. Patients with prior CABG, who were at higher baseline cardiovascular risk, experienced fewer serious adverse events with semaglutide (38%) compared to placebo (44%), reinforcing its efficacy and safety in this high-risk subgroup.

The SELECT trial demonstrated that semaglutide 2.4 mg administered once weekly reduced major adverse cardiovascular events (MACE) in patients with overweight or obesity and established cardiovascular disease (CVD), irrespective of a history of coronary artery bypass grafting (CABG). In a prespecified subgroup analysis of 17,604 patients, semaglutide consistently reduced cardiovascular risk compared with placebo, with a greater absolute risk reduction in those with prior CABG.

Patients with a history of CABG (n=2,057; 12%) were older (mean age 65.0 vs. 61.5 years), predominantly male (84%), and had higher rates of atrial fibrillation, heart failure, obstructive sleep apnea, and coronary heart disease than those without prior CABG. They were also more likely to receive medications such as beta-blockers, diuretics, and statins. These patients were at higher baseline cardiovascular risk, as evidenced by the placebo group’s greater incidence of MACE (3.4% vs. 2.3%), cardiovascular death (1.5% vs. 0.8%), and all-cause mortality (2.3% vs. 1.5%) compared to patients without CABG.

Semaglutide significantly reduced the risk of MACE in both groups. In patients with prior CABG, the hazard ratio (HR) for MACE was 0.72 (95% CI, 0.54–0.95), while in those without CABG, the HR was 0.82 (95% CI, 0.73–0.92), with a p-interaction of 0.39, indicating no significant difference in relative efficacy. The absolute risk reduction at 156 weeks was 2.3% (95% CI, −0.01% to 4.8%) in the CABG group compared to 1.0% (95% CI, 0.2% to 1.8%) in the non-CABG group. These results underscore the robust efficacy of semaglutide across key cardiovascular outcomes, including extended MACE and all-cause mortality, regardless of CABG history. Patients with prior CABG in the semaglutide group also experienced fewer serious adverse events (38%) compared to placebo (44%). Overall, semaglutide was well tolerated, with no significant differences in safety outcomes between patients with or without CABG.

This study reinforces semaglutide’s role as a key therapy for reducing cardiovascular events in diverse high-risk populations.