Alex D Michaels, MD, J. Hunter Mehaffey, MD, MSc, Robert B Hawkins, MD, MSc, John A Kern, MD, Bruce D Schirmer, MD, Peter T Hallowell, MD. University of Virginia
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 coronary artery disease and coronary revascularization procedures.
Methods and Procedures: All patients who underwent bariatric surgery at a single medical center from 1995-2015 were identified. A control population of morbidly obese patients who did not undergo bariatric surgery was identified using our institutional clinical data repository over the same study period to propensity match 1:1 on patient demographics and comorbidities. Univariate analyses were performed to compare outcomes in the surgery and non-surgery groups.
Results: A total of 3,242 bariatric surgery patients and 45,750 nonsurgical patients were identified. After 1:1 propensity score matching, a total of 3,242 patients in each group were found to be well balanced with no differences in baseline risk factors. With a median follow-up of 7.2 years, the surgery group had significantly lower rates of myocardial infarction, cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass grafting (Table).
Conclusions: Bariatric surgery was associated with a significant reduction in the incidence of coronary events as well as lower rates of coronary revascularization in a propensity-matched cohort of morbidly obese patients. These outcomes support increased utilization of bariatric surgery for the prevention of heart disease.
| Preoperative | Non-Surgery (n=3,242) | Surgery (n=3,242) | P-value |
| Age (Years) | 43.0(32.0-53.0) | 43.1(36.0-51.0) | 0.0003 |
| Race (White) | 2,874(88.7%) | 2,854(88.0%) | 0.44 |
| Body Mass Index (kg/m2) | 47.7(41.1-56.7) | 48.0(43.3-54.8) | 0.12 |
| Private Insurance | 2,076(64.0%) | 2,008(61.9%) | 0.08 |
| Diabetes Mellitus | 877(27.1%) | 889(27.4%) | 0.74 |
| Hypertension | 1,581(48.8%) | 1,589(49.0%) | 0.84 |
| Tobacco Usage | 73(2.3%) | 63(1.9%) | 0.39 |
| Coronary Artery Disease | 402(12.4%) | 421(13.0%) | 0.48 |
| Postoperative | |||
| Myocardial Infarction | 323(10.0%) | 57(1.8%) | <0.0001 |
| Coronary Catheterization | 286(8.8%) | 60(1.9%) | <0.0001 |
| Percutaneous Coronary Intervention | 252(7.8%) | 13(0.4%) | <0.0001 |
| Coronary Artery Bypass Grafting | 75(2.3%) | 18(0.6%) | <0.0001 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93992
Program Number: S154
Presentation Session: Plenary II
Presentation Type: Podium
