TY - JOUR
T1 - Survival Following Alcohol Septal Ablation or Septal Myectomy for Patients With Obstructive Hypertrophic Cardiomyopathy
AU - Cui, Hao
AU - Schaff, Hartzell V.
AU - Wang, Shuiyun
AU - Lahr, Brian D.
AU - Rowin, Ethan J.
AU - Rastegar, Hassan
AU - Hu, Shengshou
AU - Eleid, Mackram F.
AU - Dearani, Joseph A.
AU - Kimmelstiel, Carey
AU - Maron, Barry J.
AU - Nishimura, Rick A.
AU - Ommen, Steve R.
AU - Maron, Martin S.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/5/3
Y1 - 2022/5/3
N2 - Background: There is little information regarding long-term mortality comparing the 2 most common procedures for septal reduction for obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA), and septal myectomy. Objectives: This study sought to compare the long-term mortality of patients with obstructive HCM following septal myectomy or ASA. Methods: We evaluated outcomes of 3,859 patients who underwent ASA or septal myectomy in 3 specialized HCM centers. All-cause mortality was the primary endpoint of the study. Results: In the study cohort, 585 (15.2%) patients underwent ASA, and 3,274 (84.8%) underwent septal myectomy. Patients undergoing ASA were significantly older (median age: 63.0 years [IQR: 52.7-72.8 years] vs 53.7 years [IQR: 44.9-62.8 years]; P < 0.001) and had smaller septal thickness (19.0 mm [IQR: 17.0-22.0 mm] vs 20.0 mm [IQR: 17.0-23.0 mm]; P = 0.007). Patients undergoing ASA also had more comorbidities, including renal failure, diabetes, hypertension, and coronary artery disease. There were 4 (0.7%) early deaths in the ASA group and 9 (0.3%) in the myectomy group. Over a median follow-up of 6.4 years (IQR: 3.6-10.2 years), the 10-year all-cause mortality rate was 26.1% in the ASA group and 8.2% in the myectomy group. After adjustment for age, sex, and comorbidities, the mortality remained greater in patients having septal reduction by ASA (HR: 1.68; 95% CI: 1.29-2.19; P < 0.001). Conclusions: In patients with obstructive hypertrophic cardiomyopathy, ASA is associated with increased long-term all-cause mortality compared with septal myectomy. This impact on survival is independent of other known factors but may be influenced by unmeasured confounding patient characteristics.
AB - Background: There is little information regarding long-term mortality comparing the 2 most common procedures for septal reduction for obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA), and septal myectomy. Objectives: This study sought to compare the long-term mortality of patients with obstructive HCM following septal myectomy or ASA. Methods: We evaluated outcomes of 3,859 patients who underwent ASA or septal myectomy in 3 specialized HCM centers. All-cause mortality was the primary endpoint of the study. Results: In the study cohort, 585 (15.2%) patients underwent ASA, and 3,274 (84.8%) underwent septal myectomy. Patients undergoing ASA were significantly older (median age: 63.0 years [IQR: 52.7-72.8 years] vs 53.7 years [IQR: 44.9-62.8 years]; P < 0.001) and had smaller septal thickness (19.0 mm [IQR: 17.0-22.0 mm] vs 20.0 mm [IQR: 17.0-23.0 mm]; P = 0.007). Patients undergoing ASA also had more comorbidities, including renal failure, diabetes, hypertension, and coronary artery disease. There were 4 (0.7%) early deaths in the ASA group and 9 (0.3%) in the myectomy group. Over a median follow-up of 6.4 years (IQR: 3.6-10.2 years), the 10-year all-cause mortality rate was 26.1% in the ASA group and 8.2% in the myectomy group. After adjustment for age, sex, and comorbidities, the mortality remained greater in patients having septal reduction by ASA (HR: 1.68; 95% CI: 1.29-2.19; P < 0.001). Conclusions: In patients with obstructive hypertrophic cardiomyopathy, ASA is associated with increased long-term all-cause mortality compared with septal myectomy. This impact on survival is independent of other known factors but may be influenced by unmeasured confounding patient characteristics.
KW - alcohol septal ablation
KW - hypertrophic cardiomyopathy
KW - left ventricular outflow tract obstruction
KW - septal myectomy
KW - septal reduction therapy
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U2 - 10.1016/j.jacc.2022.02.032
DO - 10.1016/j.jacc.2022.02.032
M3 - Article
C2 - 35483751
AN - SCOPUS:85128659127
SN - 0735-1097
VL - 79
SP - 1647
EP - 1655
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 17
ER -