Presence of coronary artery disease increases the risk of biliary events in patients with asymptomatic gallstones
- 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.
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:email@example.com
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.
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.
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).
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.