Safety of bariatric surgery in patients with coronary artery disease

Background: Patients with obesity and established coronary artery disease (CAD) may benefit from surgical weight loss; however, its safety is unknown in this population. Objective: To assess the association between CAD and the incidence of 30-day postoperative mortality and major adverse cardiac events (MACEs) in patients undergoing bariatric surgery. Settings: Multicenter cohort study. Methods: We used the 2017 MBSAQIP database to study patients undergoing bariatric surgery from accredited centers in the United States and Canada between Jan 1, 2017, and Dec 31, 2017. Multivariate logistic regression was used to determine whether established CAD was independently associated with 30-day mortality and MACE, a composite endpoint that included myocardial infarction and/or cardiac arrest. Results: We reviewed data from 167,819 patients from 832 centers. There were 4172 patients with diagnosed CAD, and 163,647 without it. At 30-day follow-up, the endpoints of mortality, cardiac arrest, myocardial infarction, and MACE occurred in 172 (.10%), 82 (.05%), 57 (.03%), and 135 (.08%) patients, respectively. The endpoints occurred more significantly in patients with CAD compared with patients without CAD; 22 (.53%) versus 150 (.09%) for mortality, 13 (.31%) versus 69 (.04%) for cardiac arrest, 17 (.41%) versus 40 (.02%) for myocardial infarction, and 28 (.67%) versus 107 (.07%) for MACE (P < .001 for all comparisons). Conclusions: Postoperative mortality and MACE following bariatric surgery are higher in patients with CAD than those without; however, the absolute incidence is low (<1%). 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.