Impact of coronary artery revascularization on long-term outcome in hypertrophic cardiomyopathy patients: a nationwide population-based cohort study

Abstract

Limited data are available on the long-term outcomes in patients with hypertrophic cardiomyopathy (HCM) patients with significant coronary artery disease (CAD) requiring revascularization. We investigated the risk of cardiovascular outcomes in HCM patients who underwent coronary revascularization compared to the control group without HCM. HCM patients aged ≥ 20 years were enrolled from the Korean National Health Insurance Database. Information on the diagnosis and previous medical history was obtained from the claims data. Cardiovascular outcomes were identified during 8-year after coronary revascularization in HCM patients (HCM group) and matched controls without HCM (non-HCM control group). A total of 431 patients in the HCM group and 1968 in the non-HCM control group were analyzed. The risk of all-cause death, cardiovascular death, sudden cardiac death (SCD), ischemic stroke, and hospitalization due to heart failure was significantly higher in the HCM group than in the non-HCM group, with prominent risk increase of cardiovascular death (adjusted hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.63-3.15, P < 0.001) and ischemic stroke (adjusted HR 2.38, 95% CI 1.55-3.64, P < 0.001). Beyond 1-year after revascularization, the HCM group still had a significantly higher risk of cardiovascular death, SCD, and ventricular fibrillation/tachycardia compared to the non-HCM group. Mortality and major cardiovascular outcomes occurred more frequently in HCM patients with significant CAD requiring revascularization, compared to the matched non-HCM control group. Active and regular surveillance for concomitant risk factors and relevant intervention are warranted in HCM patients at increased risk for CAD.

Figure 1

Study flow. From the Korean National Health Information Database, participants aged ≥ 20 were screened and patients with HCM were identified during 2010–2016. Control group without HCM was selected by 1:5 matching of age and sex. The HCM group and non-HCM control group who underwent PCI or CABG during the study period were analyzed. Abbreviations: CABG, coronary artery bypass graft; HCM, hypertrophic cardiomyopathy; Hx, history; PCI, percutaneous coronary intervention.

Figure 2

Cumulative incidence and risk of cardiovascular outcomes in HCM versus non-HCM Control Group. Kaplan–Meier curves of (A) All-cause death, (B) Cardiovascular death, (C) Sudden cardiac death, (D) Ischemic stroke, (E) Hospitalization due to HF, and (F) Ventricular fibrillation/tachycardia in the HCM group versus non-HCM control group are presented. Abbreviations: HCM, hypertrophic cardiomyopathy; HF, heart failure.

Figure 3

Landmark analysis of major cardiovascular outcomes in HCM versus non-HCM control group. Cumulative incidence and 1-year landmark analyses of (A) Cardiovascular death, (B) Sudden cardiac death, and (C) Ventricular fibrillation/tachycardia is presented. Abbreviations: HCM, hypertrophic cardiomyopathy; IR, incidence rate; p-y, person-year; Y, year.

Figure 4

Subgroup analysis for all-cause death and cardiovascular death. Subgroup analyses across various exploratory subgroups for all-cause death and cardiovascular death are shown. Abbreviations: AMI, acute myocardial infarction; CI, confidence interval; HCM, hypertrophic cardiomyopathy; HR, hazard ratio; IR, incidence rate; p-y, person-year.