Quebec Heart-Lung Institute, 2725, Chemin Ste Foy, Quebec, Quebec, G1V 4G5, Canada.
Faculty of Pharmacy, Laval University, Quebec, Canada.
Obes Surg. 2020 Jun;30(6):2085-2092. doi: 10.1007/s11695-020-04467-7.
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.
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.
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 follow-up 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).
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.
肥胖合并严重冠状动脉疾病（CAD）患者行减重手术的临床获益尚不明确。本研究旨在比较合并及不合并 CAD 的肥胖患者行减重手术后的心血管结局。
从一个专用数据库中识别出在减重手术前有记录的心肌血运重建病史的患者，该数据库前瞻性地收集了患者的结局数据。这些患者与有既往血运重建史但未行减重手术的 CAD 患者按 1:1 匹配。主要终点为全因死亡（心源性和非心源性）和主要不良心脑血管事件（MACCE），包括死亡、心肌梗死（MI）、卒中和随访期间再次血运重建。
经倾向评分匹配后，116 例减重患者与 116 例对照患者相匹配。98 例患者有冠状动脉旁路移植术史，134 例患者有经皮冠状动脉介入治疗史。中位随访 8.9（6.3-14.2）年后，减重组的 MACCE 明显更低（HR 0.65；95%CI 0.42-1.00；P=0.049），主要归因于非心源性死亡率的显著降低（HR 0.49；95%CI 0.23-1.00；P=0.049）。全因死亡率（HR 0.58；95%CI 0.33-1.01；P=0.056）、心血管死亡率（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）、卒中和再次血运重建（HR 1.47；95%CI 0.24-11.2；P=0.67）的发生率在两组间无显著差异。
虽然肥胖 CAD 患者行减重手术可能会降低长期随访期间的复合 MACCE 终点事件发生率，但这种效果似乎与心血管结局无关。
