Outcomes in Patients with Obesity and Coronary Artery Disease with and Without Bariatric Surgery
- PDF / 871,230 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 31 Downloads / 202 Views
ORIGINAL CONTRIBUTIONS
Outcomes in Patients with Obesity and Coronary Artery Disease with and Without Bariatric Surgery Charles Pirlet 1 & Pierre Voisine 1 & Paul Poirier 1,2 & Tomas Cieza 1 & Zoltan Ruzsa 3 & Rodrigo Bagur 4 & François Julien 1 & Frédéric-Simon Hould 1 & Laurent Biertho 1 & Olivier F Bertrand 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objectives The clinical benefit of bariatric surgery in patients with severe obesity and established coronary artery disease (CAD) is unclear. We aimed to compare the cardiovascular outcomes of severely obese CAD patients with and without bariatric surgery. Methods Patients with a history of myocardial revascularization documented prior to bariatric surgery were identified from a dedicated database with prospectively collected outcomes. These patients were matched 1 to 1 with CAD patients who had prior revascularization but who did not undergo bariatric surgery. The primary outcomes were death (cardiac and non-cardiac) and major adverse cardio-cerebral events (MACCE), including death, myocardial infarction (MI), stroke, and repeat myocardial revascularization throughout follow-up. Results After propensity score matching, 116 bariatric patients were matched with 116 control patients. Ninety-eight had a history of coronary artery bypass surgery and 134 had a previous percutaneous coronary intervention. After a median followup of 8.9 (6.3–14.2) years, MACCE was significantly lower in the bariatric group (HR 0.65; 95% CI 0.42–1.00; P = 0.049) driven by a significant reduction in non-cardiac mortality (HR 0.49; 95% CI 0.23–1.00; P = 0.049). There was no significant difference in the rates of all-cause death (HR 0.58; 95% CI 0.33–1.01; P = 0.056), cardiovascular death (HR 0.77; 95% CI 0.31– 1.85; P = 0.55), MI (HR 1.09; 95% CI 0.47–2.58; P = 0.85), stroke (HR 1.47; 95% CI 0.24–11.2; P = 0.67), and repeat myocardial revascularization (HR 0.56; 95% CI 0.27–1.13; P = 0.11). Conclusion Although bariatric surgery in obese CAD patients may reduce the composite MACCE endpoint during long-term follow-up, this effect seems unrelated to cardiovascular outcomes. Keywords Bariatric surgery . Cardiovascular risk . Prevention . Coronary artery disease
Introduction Obesity is commonly encountered in patients with coronary artery disease (CAD), affecting up to 38% of patients Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04467-7) contains supplementary material, which is available to authorized users. * Olivier F Bertrand [email protected] 1
Quebec Heart-Lung Institute, 2725, Chemin Ste Foy, Quebec, Quebec G1V 4G5, Canada
2
Faculty of Pharmacy, Laval University, Quebec, Canada
3
Semmelweiss University, Budapest, Hungary
4
London Health Sciences Centre, London, Ontario, Canada
[1–3]. Yet little data and few recommendations exist to guide clinicians in how to treat obesity in patients with established CAD. Bariatric surgery is currently the only efficient treatment modal
Data Loading...
