Postoperative mortality and major adverse cardiac events (MACEs) following bariatric surgery are higher in patients with coronary artery disease (CAD) than those without, however, the absolute incidence is low (<1%), according to researchers from Penn State College of Medicine, Hershey, PA.
The study, ‘Safety of bariatric surgery in patients with coronary artery disease’, published in SOARD, sought to investigate the association between CAD and the incidence of 30-day postoperative MACEs in of patients with obesity and established CAD who undergo bariatric surgery.
This multi-centre cohort study examined data from the 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database to study patients undergoing bariatric surgery from accredited centres in the US and Canada between January 2017 and December 2017. The study included data from 167,819 patients from 832 centres; 4,172 patients with diagnosed CAD and 163,647 without. The researchers used multivariate logistic regression determine whether established CAD was independently associated with 30-day mortality and MACE, a composite endpoint that included myocardial infarction and/or cardiac arrest.
The outcomes showed that at 30-day follow-up, the endpoints of mortality, cardiac arrest, myocardial infarction, and MACE occurred in 172 (0.10%), 82 (0.05%), 57 (0.03%) and 135 (0.08%) patients, respectively. The endpoints occurred more significantly in patients with CAD compared with patients without CAD; 22 (0.53%) versus 150 (0.09%) for mortality, 13 (0.31%) versus 69 (0.04%) for cardiac arrest, 17 (0.41%) versus 40 (0.02%) for myocardial infarction and 28 (.67%) vs 107 (0.07%) for MACE ( p<0.001 for all comparisons).
“The decision to pursue bariatric surgery and/or preoperative cardiac testing in patients with CAD should include consideration of the overall incidence of adverse cardiac outcomes and the stability of CAD,” the authors concluded.