Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA, 22901, USA.
Surg Endosc. 2020 Jun;34(6):2638-2643. doi: 10.1007/s00464-019-07036-x. Epub 2019 Aug 2.
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.
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.
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.
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.
肥胖和肥胖相关的合并症与冠心病（CAD）的风险增加有关。减重手术可实现持久的体重减轻和对众多 CAD 风险因素的改善，但关于 CAD 相关结局的数据有限。我们假设减重手术将降低 CAD 的风险并减少冠状动脉血运重建术的发生率。
从 1985 年到 2015 年，在一个医疗中心接受减重手术的所有患者均被识别。在同一研究期间，使用机构临床数据存储库确定了一组未接受减重手术的病态肥胖患者作为对照组，按照患者人口统计学特征和合并症（包括心脏病史）进行 1:1 倾向评分匹配。对手术组和非手术组的结果进行单变量分析。
共识别出 3410 名减重手术患者和 45750 名非手术患者。在 1:1 倾向评分匹配后，每组各有 3242 名患者在基线特征和危险因素方面得到很好的平衡。中位随访时间超过 6 年，手术组心肌梗死（1.8% vs. 10.0%；RR 0.18）、冠状动脉造影（1.9% vs. 8.8%；RR 0.22）、经皮冠状动脉介入治疗（0.4% vs. 7.8%；RR 0.05）和冠状动脉旁路移植术（0.6% vs. 2.3%；RR 0.26）的发生率明显较低。在有或没有糖尿病的患者亚组中也观察到了类似的获益。
在匹配了病态肥胖患者的倾向评分后，减重手术与心肌梗死发生率显著降低以及冠状动脉血运重建术的发生率较低相关。尽管这项研究的回顾性可能存在一定程度的选择偏倚，但这些结果支持增加减重手术用于预防心脏病。
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