Presence of coronary artery disease increases the risk of biliary events in patients with asymptomatic gallstones

Authors

  • Yoon Suk Lee,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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  • Sang Eon Jang,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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  • Ban Seok Lee,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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  • Seung-June Lee,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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  • Min Geun Lee,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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  • Joo Kyung Park,

    1. Department of Healthcare Gangnam Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Sang Hyub Lee,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Ji Kon Ryu,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Yong-Tae Kim,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Yong Bum Yoon,

    1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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  • Jin-Hyeok Hwang

    Corresponding author
    • Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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  • Conflict of interest: The authors declare that they have no conflict of interest.
  • Grant support: None.
  • Author contributions: Yoon Suk Lee: study concept and design, data acquisition and interpretation, and drafting of the manuscript; Sang Eon Jang, Ban Seok Lee, Seung-June Lee, and Min Geun Lee: study concept and design, and data acquisition; Sang Hyub Lee, Joo Kyung Park, Ji Kon Ryu, Yong-Tae Kim, and Yong Bum Yoon: study supervision and critical review of the manuscript; Jin-Hyeok Hwang: study concept and design, data acquisition and interpretation, study supervision, and critical review of the manuscript.

Correspondence

Dr Jin-Hyeok Hwang, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Republic of Korea. Email:woltoong@snu.ac.kr

Abstact

Background and Aim

Propensity score indicates a probability of having a confounding factor. It is used to match each patient with the closest propensity score between two groups, which is known as propensity score matching. This study aimed to evaluate the gallstone-related biliary events, defined as biliary colic and acute cholecystitis between coronary artery disease (CAD) and non-CAD patients using propensity score matching.

Methods

This retrospective cohort study evaluated 267 asymptomatic gallstone patients with CAD and 459 asymptomatic gallstone patients without CAD from March 2003 to December 2009 at two tertiary teaching hospitals in the Republic of Korea. After propensity score matching, total 378 patients, including 126 in study group (with CAD) and 252 in control group (without CAD), were evaluated.

Results

During a median follow-up of 47 months, overall gallstone-related biliary event rate was 33.5% in the study group and 27.5% in the control group. The 5-year cumulative rates were 25.3% versus 17.7% in gallstone-related biliary event and 10.9% versus 1.6% in acute cholecystitis (study versus control group). After propensity score adjustment, the risk of gallstone-related biliary events in the CAD patients significantly increased (hazard ratio 2.11, 95% confidence interval 1.14–3.90, P = 0.017 in matched patients).

Conclusion

In patients with asymptomatic gallstones, the coexistence of CAD can increase the risk of gallstone-related biliary events, particularly acute cholecystitis. Therefore, gallstone patients with CAD should be carefully monitored, even if they are asymptomatic.

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