Safety and efficacy of bariatric surgery in patients with coronary artery disease

OBJECTIVE: To determine the safety and efficacy of bariatric surgery in obese patients with documented coronary artery disease (CAD). PATIENTS AND METHODS: Among patients with class II or III obesity who underwent bariatric surgery between March 1995 and January 2002 at the Mayo Clinic in Rochester, Minn, the rates of major in-hospital cardiovascular complications and mortality of 52 patients with clinical CAD were compared with those of 507 patients without CAD. The efficacy of bariatric surgery was measured by changes in body weight and other cardiovascular risk factors at follow-up. RESULTS: There were no in-hospital deaths in either group. Three patients with documented CAD (5.8%; 95% confidence interval, 0%-12.2%) and 7 patients without CAD (1.4%; 95% confidence interval, 0.4%-2.4%) had cardiovascular complications (P=.06). After a mean follow-up of 2.5 years (range, 77-2403 days) of patients with CAD, the following values decreased postoperatively (all at P<.001): weight, from 147±36 kg to 103±22 kg; body mass index, from 50±11 kg/m² to 36±9 kg/m²; fasting serum glucose, from 149±52 mg/dL to 113±31 mg/dL; glycosylated hemoglobin, from 9%±3% to 6%±2%; and blood pressure, from 142/82 mm Hg to 132/73 mm Hg. Low-density lipoprotein cholesterol decreased postoperatively from 116±31 mg/dL to 75±26 mg/dL, and triglycerides decreased from 198±85 mg/dL to 119±52 mg/dL (P<.01 for both). CONCLUSION: Bariatric surgery should be considered for treating patients with CAD and class II or III obesity.