GLP-1 Receptor Agonists Across the Coronary Disease Continuum in Type 2 Diabetes: A Systematic Review of Ischemic Events, Revascularization, and Stent Healing

Type 2 diabetes is associated with accelerated coronary atherosclerosis, recurrent ischemic events, and impaired vascular healing after percutaneous coronary intervention (PCI); however, the effects of glucagonlike peptide-1 (GLP-1) receptor agonists across these distinct coronary outcomes remain incompletely characterized.This systematic review synthesized randomized evidence on myocardial infarction (MI), acute coronary syndrome (ACS), coronary revascularization, post-PCI healing, and mechanistic markers of coronary disease.MEDLINE via PubMed, Scopus, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials (CENTRAL) were initially searched for eligible reports published from January 1, 2020, through December 31, 2025.All four database searches were updated on August 31, 2026, extending publication eligibility through that date; no additional eligible reports were identified.The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.Seven eligible reports derived from seven parent randomized trials, involving 37,033 participants, were included.Two presented primary findings from independent randomized trials, three were prespecified analyses of parent randomized trials, and two were post hoc analyses.Owing to substantial clinical and outcome heterogeneity, the findings were synthesized narratively.Albiglutide reduced first and recurrent MI, including type 1 and type 2 events, whereas higher-dose efpeglenatide yielded more favorable cardiovascular effect estimates than the lower dose.Across separate reports, semaglutide favorably modified epicardial adipose tissue, a surrogate imaging measure, and reduced the composite of cardiovascular death, MI, or stroke in patients with diabetic kidney disease.Liraglutide was associated with lower risks of broader cardiovascular composites compared with the other glucose-lowering therapies combined, although individual MI and revascularization outcomes were not significantly reduced.Exenatide did not significantly reduce the composite of hospitalization for ACS or coronary revascularization, and the only PCI-specific trial demonstrated no significant improvement in early stent coverage, neointimal thickness, or in-stent obstruction.Of the seven included reports, one was judged to have a low risk of bias, whereas six raised some concerns, primarily because of post hoc analyses, open-label treatment, incomplete methodological reporting, or limited imaging follow-up.Across the included reports, findings were more favorable for MI and broader cardiovascular events than for coronary revascularization or post-stent healing.However, the small number of heterogeneous reports, reliance on several secondary or post hoc analyses, and absence of quantitative meta-analysis limit firm conclusions and do not establish a definitive class-wide coronary effect.Potential differences by agent, dose, and patient phenotype require further investigation, while treatment-initiation timing remains largely untested.