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Cirugía bariátrica y resultados cardiovasculares en pacientes con obesidad y enfermedad cardiovascular: un estudio de
Aristithes G Doumouras1,2, Jorge A Wong3,4, J Michael Paterson5,2,6
1Division of General Surgery (A.G.D., Y.L., D.H., M.A.), McMaster University, Hamilton, Ontario, Canada.
Circulation
|April 5, 2021
Resumen
La cirugía bariátrica reduce significativamente los eventos adversos cardiovasculares mayores (EACM) en pacientes con obesidad y enfermedad cardiovascular existente. Esto incluye un menor riesgo de mortalidad, ataque cardíaco y hospitalización por insuficiencia cardíaca.
Área de la Ciencia:
- Cardiología
- Cirugía metabólica
- Medicina para la obesidad
Sus antecedentes:
- Se sabe que la cirugía bariátrica mejora los factores de riesgo cardiovascular.
- Su impacto en los eventos adversos cardiovasculares mayores (MACE) en pacientes con enfermedad cardiovascular establecida (ECV) y obesidad grave no se conoce bien.
Objetivo del estudio:
- Investigar la asociación entre la cirugía bariátrica y el MACE en pacientes con ECV y obesidad severa.
Principales métodos:
- Un estudio de cohorte con puntuación de propensión utilizó bases de datos administrativas de toda la provincia canadiense.
- 1319 pacientes sometidos a cirugía bariátrica fueron emparejados 1:1 con controles con enfermedad cardíaca isquémica previa o insuficiencia cardíaca.
- El resultado primario fue la ECMA prolongada (mortalidad por cualquier causa, infarto de miocardio, revascularización coronaria, eventos cerebrovasculares, hospitalización por insuficiencia cardíaca).
Principales resultados:
- Durante una mediana de seguimiento de 4,6 años, la cirugía bariátrica se asoció con una reducción del 42% en el MACE prolongado (HR ajustada, 0, 58; P< 0, 001).
- Se observaron reducciones significativas del riesgo en pacientes con insuficiencia cardíaca (HR, 0,44) y enfermedad cardíaca isquémica (HR, 0,60).
- La cirugía bariátrica también redujo la incidencia de un MACE de 3 componentes y la mortalidad cardiovascular.
Conclusiones:
- La cirugía bariátrica está relacionada con la disminución de la MACE en pacientes obesos con enfermedad cardiovascular.
- Se requiere una mayor validación a través de ensayos controlados aleatorios a gran escala.
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