Prognostic Value of Negative Coronary CT Angiography in Severely Obese Patients Prior to Bariatric Surgery: a Follow-Up After 6 Years.

Abstract

BACKGROUND:

This study aims to determine the long-term prognostic value of coronary CT angiography (CCTA) prior to bariatric surgery in severely obese patients with a body mass index (BMI) ≥35 kg/m2.

MATERIAL AND METHODS:

Seventy consecutive patients undergoing cardiac CT for coronary assessment prior to bariatric surgery were prospectively included. Images were analysed for the presence of coronary calcification and for non-obstructive (<50%) or obstructive (>50% stenosis) coronary artery disease (CAD). A median clinical follow-up of 6.1 years in 54 patients was obtained for major adverse cardiovascular events (MACEs), defined as death, non-fatal myocardial infarction or coronary revascularisation. Weight loss and BMI decrease following bariatric surgery were recorded.

RESULTS:

The median BMI prior to surgery was 46.9 kg/m2. The median percentage of excess BMI loss after surgery was 75%. CT showed coronary calcification in 26 (48%) patients, whereas 28 (52%) patients had no calcification. CCTA revealed normal coronaries in 47 (87%) and non-obstructive CAD in 7 (13%) patients. No obstructive CAD was found. All patients successfully underwent bariatric surgery, and no MACE occurred neither perioperatively nor in the follow-up period. The negative predictive value of CCTA was 100% (95% confidence interval of 90.1-100.0%).

CONCLUSIONS:

In severely obese patients, the absence of obstructive CAD in cardiac CT prior to bariatric surgery with subsequently marked weight reduction has strong long-term prognostic implications for ruling out major adverse cardiac events in the postoperative period.

• Authors: Michael Messerli, Céline Maywald, Stephan Wälti, René Warschkow, Simon Wildermuth, Hatem Alkadhi, Sebastian Leschka, Marc Schiesser
• Journal: Obesity surgery (Obes Surg) Vol. 27 Issue 8 Pg. 2044-2049 (08 2017) ISSN: 1708-0428 [Electronic] United States
• PMID: 28243857 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Bariatric Surgery (adverse effects)
• Calcinosis (diagnostic imaging)
• Computed Tomography Angiography
• Coronary Angiography
• Coronary Artery Disease (complications, diagnostic imaging)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Obesity (complications, surgery)
• Prognosis