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August 12, 2026Journal of the American College of CardiologyOpen Access

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

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Why the study?

Little information is available regarding long-term mortality comparing alcohol septal ablation and septal myectomy for obstructive hypertrophic cardiomyopathy.

Does alcohol septal ablation reduce or increase long-term all-cause mortality compared to septal myectomy in patients with obstructive hypertrophic cardiomyopathy?

Population

3,859 patients with obstructive HCM across 3 specialized HCM centers

Comparison

Alcohol septal ablation vs septal myectomy

Design

Multicenter cohort study

Follow-up

Median 6.4 years

Key result

Alcohol septal ablation was associated with higher long-term all-cause mortality compared to septal myectomy in obstructive hypertrophic cardiomyopathy (HR 1.68; 95% CI 1.29-2.19; P<0.001).

Authors

HCHao CuiHSHartzell V. SchaffSWShuiyun Wang

Discussion

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Overview

Caution advised selecting ASA over myectomy in obstructive HCM; leaves open confirmation of survival difference in randomized trials.

Key Points

  • This study aims to compare long-term all-cause mortality between patients undergoing alcohol septal ablation and septal myectomy for obstructive hypertrophic cardiomyopathy.
  • Evaluated 3,859 patients from 3 specialized HCM centers who underwent ASA or septal myectomy.
  • Primary endpoint was all-cause mortality.
  • Adjustments made for age, sex, and comorbidities during analysis.
  • 10-year all-cause mortality was 26.1% for ASA and 8.2% for myectomy, indicating significant differences in long-term survival.
  • After adjustment, ASA associated with higher mortality (HR: 1.68; 95% CI: 1.29-2.19; P < 0.001).
  • Early deaths occurred in 0.7% of ASA patients and 0.3% of myectomy patients.

Study Design

Type

Cohort (n=3,859)

Multicenter

Yes

Structured PICO

Does alcohol septal ablation reduce or increase long-term all-cause mortality compared to septal myectomy in patients with obstructive hypertrophic cardiomyopathy?

P
Population
3,859 patients with obstructive hypertrophic cardiomyopathy who underwent alcohol septal ablation or septal myectomy across 3 specialized centers, followed for a median of 6.4 years.
E
Exposure
Alcohol septal ablation (ASA) (n=585)
C
Comparator
Septal myectomy (n=3,274)
O
Outcome
All-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.68 (95% CI 1.29–2.19)

Absolute Event Rate: 26.1% vs 8.2%

p-value: p=< 0.001

In patients with obstructive hypertrophic cardiomyopathy, alcohol septal ablation is associated with higher long-term all-cause mortality compared to septal myectomy, even after adjusting for baseline differences.

Limitations

  • May be influenced by unmeasured confounding patient characteristics

Cite This Study

Cui et al. (2022) conducted a cohort in Obstructive hypertrophic cardiomyopathy (n=3,859). Alcohol septal ablation vs. Septal myectomy was evaluated on All-cause mortality (HR 1.68, 95% CI 1.29-2.19, p=< 0.001). Alcohol septal ablation was associated with higher long-term all-cause mortality compared to septal myectomy in obstructive hypertrophic cardiomyopathy (HR 1.68; 95% CI 1.29-2.19; P<0.001).

synapsesocial.com/papers/6a7ce342939ceeb56f39b981https://doi.org/10.1016/j.jacc.2022.02.032
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