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Observational Study
. 2019 Jul;12(7):e007673.
doi: 10.1161/CIRCINTERVENTIONS.118.007673. Epub 2019 Jul 12.

Guideline-Based Referral for Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy Is Associated With Excellent Clinical Outcomes

Carey Kimmelstiel  1   2 , David C Zisa  1 , Johny S Kuttab  1 , Sophie Wells  1 , James E Udelson  1 , Benjamin S Wessler  1 , Hassan Rastegar  2   3 , Navin K Kapur  1 , Andrew R Weintraub  1 , Barry J Maron  1   2 , Martin S Maron  1   2 , Ethan J Rowin  1   2
Affiliations
Observational Study

Guideline-Based Referral for Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy Is Associated With Excellent Clinical Outcomes

Carey Kimmelstiel et al. Circ Cardiovasc Interv. 2019 Jul.

Abstract

Background: The outcome of medically refractory patients with obstructive hypertrophic cardiomyopathy treated according to the American College of Cardiology/American Heart Association consensus guideline recommendations is not known. The objectives of this study were to define the short- and long-term outcomes of medically refractory obstructive hypertrophic cardiomyopathy patients undergoing alcohol septal ablation (ASA) and surgical septal myectomy (SM) with patient management in accordance with these consensus guidelines, as well as to quantify procedural risk and burden of comorbid conditions at the time of treatment.

Methods and results: Patients with obstructive hypertrophic cardiomyopathy referred for either ASA or SM from 2004 to 2015 were followed for the primary end point of short- and long-term mortality and compared with respective age- and sex-matched US populations. Of 477 consecutive severely symptomatic patients, 99 underwent ASA and 378 SM. Compared with SM, ASA patients were older ( P<0.001), had a higher burden of comorbid conditions ( P<0.01), and significantly higher predicted surgical mortality ( P<0.005). Procedure-related mortality was 0.3% and similarly low in both groups (0% in ASA and 0.8% in SM). Over 4.0±2.9 years of follow-up, 95% of patients had substantial improvement in heart failure symptoms to New York Heart Association class I/II (96% in SM and 90% in ASA). Long-term mortality was similar between the 2 groups with no difference compared with age- and sex-matched US populations.

Conclusions: Guideline-based referral for ASA and SM leads to excellent outcomes with low procedural mortality, excellent long-term survival, and improvement in symptoms. These outcomes occur in ASA patients despite being an older cohort with significantly more comorbidities.

Keywords: alcohol septal ablation; heart failure; hypertrophic cardiomyopathy; surgical myectomy.

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Figures

Figure 1.
Figure 1.. Comorbidity indices.
Four different comorbidity indices for alcohol septal ablation (ASA) and surgical septal myectomy (SM) patients. For each index, ASA patients were at significantly elevated risk as compared with SM patients. HHS indicates Health and Human Service; and STS, Society of Thoracic Surgeons.
Figure 2.
Figure 2.. Alcohol volumes.
Volumes of alcohol used in consecutive cases grouped by quintiles. Despite historical use of low alcohol volumes, over time, there was a significant reduction in the volume of alcohol used.
Figure 3.
Figure 3.. Mortality of surgical septal myectomy (SM) and alcohol septal ablation (ASA) patients compared with controls.
The survival of SM and ASA patients over follow-up was compared with age- and sex-matched US general population. The survival of both SM and ASA patients did not differ from their respective control population.
See this image and copyright information in PMC

References

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