Survival Following Alcohol Septal Ablation or Septal Myectomy for Patients With Obstructive Hypertrophic Cardiomyopathy

BACKGROUND There is little information regarding tong-term mortality comparing the 2 most common procedures for septal reduction for obstructive hypertrophic cardiornyopathy (HCM), alcohol septat ablation (ASA), and septat myectomy. OBJECTIVES This study sought to compare the long-term mortality of patients with obstructive HCM following septat myectomy or ASA. METHODS We evaluated outcomes of 3,859 patients who underwent ASA or septat 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 septat 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 cardiornyopathy, 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. (C) 2022 by the American College of Cardiology Foundation.

Automated summary

This study compared the long-term mortality of patients with obstructive HCM who underwent septal myectomy or ASA. The results showed that ASA was associated with higher all-cause mortality compared to septal myectomy.