Key result
Low-dose alcohol septal ablation lowers CK-MB levels versus high doses with similar efficacy.
Why the study?
Current guidelines for alcohol septal ablation in hypertrophic obstructive cardiomyopathy do not recommend specific alcohol doses, and dosing is based on interventionalist preference rather than systematic evidence.
Does a low alcohol dose (1-2 ml) reduce CK-MB levels and maintain efficacy compared to a high alcohol dose (2-4 ml) in patients with HOCM undergoing alcohol septal ablation?
Meta-Analysis (n=1,446)
Does a low alcohol dose (1-2 ml) reduce CK-MB levels and maintain efficacy compared to a high alcohol dose (2-4 ml) in patients with HOCM undergoing alcohol septal ablation?
Mean Difference: -0.93 (95% CI -1.15–-0.72)
p-value: p=0.00001
Low-dose alcohol (1-2 ml) for septal ablation in HOCM is as effective as high-dose (2-4 ml) but results in less myocardial injury as measured by CK-MB.
Low-dose alcohol may be preferred for HOCM septal ablation to limit injury; extends meta-analytic evidence for equivalent efficacy with lower CK-MB.
BACKGROUND: Alcohol septal ablation (ASA) is recommended for moderate to severe symptomatic patients with hypertrophic obstructive cardiomyopathy. The current guidelines don not recommend particular alcohol doses and the amount of alcohol injected into the septal artery is based more on the interventionalist's decision rather than on systematic evidence. Our objective is to execute a comprehensive assessment of the efficacy and safety of low alcohol doses (1-2 ml)) in comparison to large ones (2-4 ml). METHODS: Multiple databases, encompassing PubMed, WOS, Scopus, Embase, and Cochrane library were systemically assessed from inception to October 2023. Randomized controlled trials (RCTs) and observational studies comparing low-alcohol and high-alcohol dose in patients with HOCM was included. The main outcome was creatine kinase-MB (CK-MB). The secondary ones are septal thickness, left ventricular outflow pressure gradient, and atrioventricular (AV) block. RESULTS: Eight studies, with a total of 1446 individuals, were finally involved in our investigation. low alcohol doses showed lower CK-MB levels relative to high ones (MD=-0.93, 95% CI [-1.15 to -0.72], P = 0.00001). Furthermore, in terms of septal thickness, left ventricular outflow pressure gradient, and AV block, neither of the two doses was preferred. CONCLUSION: We propose that the low alcohol dose is equally effective as the high dose. moreover, the low alcohol dose was associated with a lower CK-MB levels in comparison to the high one. PROSPERO REGISTRATION: CRD42024511537.
No takes yet. Share an insight, caveat, or question.
Elshahat et al. (2024) conducted a meta-analysis in Hypertrophic obstructive cardiomyopathy (n=1,446). Alcohol septal ablation vs. 2-4 ml (high dose) was evaluated on Creatine kinase-MB (CK-MB) (MD -0.93, 95% CI -1.15 to -0.72, p=0.00001). Low alcohol doses (1-2 ml) for septal ablation resulted in lower CK-MB levels compared to high doses (MD -0.93; 95% CI -1.15 to -0.72; P=0.00001), with similar efficacy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: