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Obes Surg. 2017 Aug;27(8):2044-2049. doi: 10.1007/s11695-017-2592-y.

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

Author information

1
Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
2
Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse, Zurich, Switzerland.
3
Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
4
Department of Radiology, CHU Sainte-Justine, University of Montreal, Montréal, Canada.
5
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
6
Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. Marc.Schiesser@kssg.ch.

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.

KEYWORDS:

Bariatric surgery; Coronary CT angiography; Long-term follow-up; Obesity; Prognosis

PMID:
28243857
DOI:
10.1007/s11695-017-2592-y
[Indexed for MEDLINE]

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