Major Adverse Cardiac Events After Gastric Bypass vs Sleeve Gastrectomy

Area of Science:

• Cardiovascular Medicine
• Bariatric Surgery
• Obesity Treatment

Background:

• Metabolic bariatric surgery is the most effective treatment for obesity and associated cardiovascular diseases.
• Sleeve gastrectomy is now more common globally than gastric bypass.
• A comparison of major adverse cardiac events (MACE) between these procedures is needed.

Purpose of the Study:

• To compare the risk of MACE in patients undergoing gastric bypass versus sleeve gastrectomy for obesity.

Main Methods:

• Population-based, inverse probability-weighted cohort study using Swiss administrative claims data (2012-2022).
• Included adult inpatients undergoing gastric bypass or sleeve gastrectomy.
• Analyzed 4-point MACE (myocardial infarction, ischemic stroke, heart failure hospitalization, all-cause mortality) and secondary outcomes.

Main Results:

• 39,067 patients included: 77.5% gastric bypass, 22.5% sleeve gastrectomy.
• Over median 5.1 years follow-up, gastric bypass had lower MACE rates (1.9% vs 3.0%; HR 0.75).
• Lower acute myocardial infarction rates drove the difference; no difference in stroke, heart failure, or mortality. Gastric bypass favored long-term outcomes, except for higher revision surgery rates.

Conclusions:

• Gastric bypass was associated with significantly lower rates of MACE compared to sleeve gastrectomy in this large cohort.
• The findings suggest potential cardiovascular advantages of gastric bypass, though sleeve gastrectomy had fewer immediate complications and revisions.
• Further research may clarify long-term trade-offs between these bariatric procedures regarding cardiovascular health and surgical outcomes.