Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a propensity-matched analysis

Alex D Michaels; J Hunter Mehaffey; Robert B Hawkins; John A Kern; Bruce D Schirmer; Peter T Hallowell

doi:10.1007/s00464-019-07036-x

Bariatric surgery reduces long-term rates of cardiac events and need for coronary revascularization: a propensity-matched analysis

Surg Endosc. 2020 Jun;34(6):2638-2643. doi: 10.1007/s00464-019-07036-x. Epub 2019 Aug 2.

Authors

Alex D Michaels¹, J Hunter Mehaffey¹, Robert B Hawkins¹, John A Kern¹, Bruce D Schirmer¹, Peter T Hallowell²

Affiliations

¹ Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA, 22901, USA.
² Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA, 22901, USA. PTH2F@virginia.edu.

PMID: 31376005
DOI: 10.1007/s00464-019-07036-x

Abstract

Background: Obesity and obesity-related comorbidities are associated with increased risk of coronary artery disease (CAD). Bariatric surgery results in durable weight loss and improvement in numerous CAD risk factors, yet limited data exist on CAD-related outcomes. We hypothesized that bariatric surgery would lead to decreased risk of CAD and reduced rates of coronary revascularization procedures.

Methods: All patients who underwent bariatric surgery at a single medical center from 1985 to 2015 were identified. A control population of morbidly obese patients who did not undergo bariatric surgery was identified using an institutional clinical data repository over the same study period, propensity score matched 1:1 on patient demographics and comorbidities including cardiac history. Univariate analyses were performed to compare outcomes in the surgery and non-surgery groups.

Results: A total of 3410 bariatric surgery patients and 45,750 non-surgical patients were identified. After 1:1 propensity-score matching, a total of 3242 patients in each group were found to be well balanced in baseline characteristics and risk factors. With a median follow-up of greater than 6 years, the surgery group had significantly lower rates of myocardial infarction (1.8% vs. 10.0%; RR 0.18), coronary catheterization (1.9% vs. 8.8%; RR 0.22), percutaneous coronary intervention (0.4% vs. 7.8%; RR 0.05), and coronary artery bypass grafting (0.6% vs. 2.3%; RR 0.26). Similar benefits were observed for subgroups of patients with and without diabetes.

Conclusions: Bariatric surgery was associated with a significant reduction in the incidence of myocardial infarction as well as lower rates of coronary revascularization in a propensity-matched cohort of morbidly obese patients. Though the retrospective nature of this study may have introduced a degree of selection bias, these outcomes support increased utilization of bariatric surgery for the prevention of heart disease.

Keywords: Bariatric surgery; CAD; Cardiac revascularization; Coronary artery disease; Long-term outcomes.

MeSH terms

Adult
Bariatric Surgery / methods*
Coronary Artery Disease / etiology*
Female
Humans
Male
Middle Aged
Propensity Score
Retrospective Studies
Risk Factors