title: Prognostic Value of Negative Coronary CT Angiography in Severely Obese Patients Prior to Bariatric Surgery: a Follow-Up After 6 Years.
abstract: 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.
  
  
  
  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.
  
  
  
  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%).
  
  
  
  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.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.|Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Messerli
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Céline
authors.initials: C
authors.lastname: Maywald
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.|Department of Radiology, CHU Sainte-Justine, University of Montreal, Montréal, Canada.
authors.forename: Stephan
authors.initials: S
authors.lastname: Wälti
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
authors.forename: René
authors.initials: R
authors.lastname: Warschkow
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Wildermuth
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.|Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.affiliation: Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. Marc.Schiesser@kssg.ch.
authors.forename: Marc
authors.initials: M
authors.lastname: Schiesser
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects; D002114:Calcinosis / Q000000981:diagnostic imaging; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011379:Prognosis
keywords: Bariatric surgery; Coronary CT angiography; Long-term follow-up; Obesity; Prognosis