Key result
Gastric bypass was associated with a similar risk of MACE compared to sleeve gastrectomy (2.8 vs 3.2 per 1000 person-years; HR 0.92, 95% CI 0.62-1.37).
Why the study?
Gastric bypass and sleeve gastrectomy both improve cardiometabolic health, but whether the long-term rate of major adverse cardiovascular events differs between the two procedures remains unclear.
Does gastric bypass reduce major adverse cardiovascular events compared to sleeve gastrectomy in patients undergoing bariatric surgery?
Cohort (n=10,480)
Yes
Does gastric bypass reduce major adverse cardiovascular events compared to sleeve gastrectomy in patients undergoing bariatric surgery?
Hazard Ratio: 0.92 (95% CI 0.62–1.37)
Absolute Event Rate: 2.8% vs 3.2%
Gastric bypass and sleeve gastrectomy are associated with a similar long-term risk of major adverse cardiovascular events, though gastric bypass carries a higher risk of complications requiring revision surgery.
Similar MACE rates after GB versus SG support individualized choice factoring revision risk; leaves open differential long-term CV benefit in randomized data.
Objective: The study aimed to assess major adverse cardiovascular events (MACEs), complications requiring revision surgery, and bariatric conversion surgery 7 years after gastric bypass (GB) and sleeve gastrectomy (SG) using real-world data. Background: GB and SG both result in weight loss and improved cardiometabolic health. Whether the long-term rate of MACE differs between the 2 bariatric procedures is unclear. Methods: In this population-based retrospective cohort study, we used inhospital National Health Registry data from January 2012 to December 2018. Patients undergoing GB were 1:1 propensity score-matched with patients who had SG. The primary outcome was the incidence of MACE, defined as acute myocardial infarction, ischemic stroke, cardiac arrest, or hospitalization for heart failure. Secondary outcomes encompassed individual MACE components, postoperative complications, and the need for bariatric conversion surgery. Results: Among 5240 propensity score-matched pairs, the incidence rate per 1000 person-years of MACE was 2.8 among patients undergoing GB and 3.2 among those undergoing SG (hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.62-1.37). Single components of MACE were not different between both groups. Patients after GB had a higher risk of long-term postoperative complications requiring a revision surgery compared with those after SG (HR, 3.53 [95% CI, 2.78-4.49]). Bariatric conversion surgery was less frequently performed among patients undergoing GB compared with patients undergoing SG (HR, 0.09 [95% CI, 0.06-0.13]). Conclusions: In this study, the performance of GB versus SG was associated with a similar risk of MACE. While postoperative complications were more frequent among patients undergoing GB, patients following SG had a higher probability of bariatric conversion surgery.
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Wildisen et al. (2023) conducted a cohort in Obesity requiring bariatric surgery (n=10,480). Gastric bypass vs. Sleeve gastrectomy was evaluated on Incidence of MACE (acute myocardial infarction, ischemic stroke, cardiac arrest, or hospitalization for heart failure) (HR 0.92, 95% CI 0.62-1.37). Gastric bypass was associated with a similar risk of MACE compared to sleeve gastrectomy (2.8 vs 3.2 per 1000 person-years; HR 0.92, 95% CI 0.62-1.37).
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