Quebec Heart-Lung Institute, Quebec, Canada.
Quebec Heart-Lung Institute, Quebec, Canada; Faculty of pharmacy, Laval University, Quebec, Canada.
Am J Cardiol. 2020 Jan 1;125(1):40-47. doi: 10.1016/j.amjcard.2019.09.041. Epub 2019 Oct 10.
There is little data regarding the risks and benefits of bariatric surgery in patients with coronary artery disease (CAD). We aimed to assess the short- and long-term cardiovascular outcomes of patients with CAD undergoing bariatric surgery. Patients with a history of CAD were identified from a dedicated database with prospectively collected outcomes, comprising all 6795 patients who underwent bariatric surgery between January 1992 and October 2017. Patients were matched with patients who did not have CAD before the bariatric surgery procedure. The primary endpoints were mortality (cardiac and noncardiac) and major adverse cardiocerebral events (MACCE), including all-cause death, myocardial infarction, stroke, and myocardial revascularization at 30 days after bariatric surgery and throughout follow-up. After propensity score matching, 249 patients with chronic CAD were matched with 249 patients without CAD. Throughout follow-up (7.4 years; interquartile range 4.1 to 11.5, maximum 22 years), mortality (mainly cardiac mortality) remained significantly higher in the CAD compared with the non-CAD group (18% vs 10%, hazard ratio [HR] 1.70, 95% confidence interval [CI]: 1.03 to 2.79, p = 0.037). At 30 days, MACCE rate was significantly higher in the CAD compared with the non-CAD group (3.6% vs 0.4%, p = 0.011), essentially driven by non-ST elevation myocardial infarctions. After 30 days, MACCE rates remained significantly higher in the CAD group (30% vs 14%, HR 2.18, 95% CI: 1.45-3.28, p = 0.0002). In conclusion, patients with severe obesity and CAD referred to bariatric surgery were at a higher risk of early and late MACCE compared with non-CAD severely obese patients. Further study is required to define how this cardiovascular risk compares with nonoperated patients.
关于冠心病（CAD）患者行减肥手术的风险和获益，相关数据较少。我们旨在评估 CAD 患者行减肥手术的短期和长期心血管结局。从一个前瞻性收集结局的专用数据库中确定 CAD 病史患者，该数据库包含 1992 年 1 月至 2017 年 10 月期间行减肥手术的所有 6795 例患者。在减肥手术前，将这些患者与没有 CAD 的患者进行匹配。主要终点是死亡率（心脏性和非心脏性）和主要不良心脑血管事件（MACCE），包括减肥手术后 30 天及整个随访期间的全因死亡、心肌梗死、卒中和血运重建。在进行倾向评分匹配后，249 例慢性 CAD 患者与 249 例无 CAD 患者相匹配。在整个随访期间（7.4 年；四分位距 4.1 至 11.5，最长 22 年），CAD 组的死亡率（主要为心脏性死亡率）明显高于非 CAD 组（18%比 10%，风险比 [HR]1.70，95%置信区间 [CI]：1.03 至 2.79，p=0.037）。在 30 天时，CAD 组的 MACCE 发生率明显高于非 CAD 组（3.6%比 0.4%，p=0.011），主要是由非 ST 段抬高型心肌梗死引起。30 天后，CAD 组的 MACCE 发生率仍明显高于非 CAD 组（30%比 14%，HR 2.18，95% CI：1.45 至 3.28，p=0.0002）。总之，与非 CAD 严重肥胖患者相比，转诊行减肥手术的严重肥胖合并 CAD 患者的早期和晚期 MACCE 风险更高。需要进一步研究来确定这种心血管风险与未手术患者相比如何。
