75% of patients with hypertrophic Cardiomyopathy present symptoms. An important group responds very well to pharmacological treatment with betablockers and calcium antagonists, and those who do not respond, or do not tolerate these drugs, receive, at present, surgery as elective treatment.
There is also alcohol septal ablation as an alternative strategy, which different studies have found favorable, even though its true benefit remains unclear, as well as the group of patients that would benefit from this treatment.
The study looked at patients undergoing surgical septal myectomy and alcohol septal ablation (ASA) since 1998 to 2019 at the Mayo Clinic and the Fuwai Hospital. In all, it included 3274 patients undergoing septal myectomy and 585 ASA.
Primary end point was all cause mortality.
The ASA patients were older, had more hypertension, diabetes, kidney failure and heart disease, but had smaller septal thickness (19 mm vs 20 mm p=0.007) and no difference in gradient.
At 30 days, mortality resulted similar: 0.7% vs 0.3% for ASA and septal myectomy respectively.
At 10 years, primary end point was higher in patients who had received ASA (26.1% vs. 8.2%), which was maintained after adjusting for variables such as age, sex and comorbidities (HR: 1.68; 95% CI: 1.29-2.19; P < 0.001).
Other parameters associated to mortality were functional class III-IV, obstructive pulmonary disease, stroke, atrial fibrillation, renal failures, diabetes and septal thickness,
Conclusion
In patients with hypertrophic cardiomyopathy, alcohol septal ablation is associated with higher mortality in the long term, regardless other known factors, even though it might be affected by confounding factors overlooked as patient characteristics.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org .
Original Title: Survival Following Alcohol Septal Ablation or Septal Myectomy for Patients With Obstructive. Hypertrophic Cardiomyopathy.
Reference: Hao Cui, et al. (J Am Coll Cardiol 2022;79:1647–1655).
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