Key result
Septal myectomy linked to ~120% higher in-hospital mortality vs. alcohol septal ablation in obstructive HCM.
Why the study?
Outcomes data comparing septal myectomy and alcohol septal ablation in hypertrophic cardiomyopathy with outflow tract obstruction are predominantly from specialized centers and lack nationwide analysis.
Does Septal Myectomy compared to Alcohol Septal Ablation affect in-hospital mortality and complications in patients with oHCM?
Observational (n=17,245)
Yes
Does Septal Myectomy compared to Alcohol Septal Ablation affect in-hospital mortality and complications in patients with oHCM?
Odds Ratio: 2.2 (95% CI 1.7–2.9)
Absolute Event Rate: 2.5% vs 1.3%
p-value: p=<0.001
In a nationwide analysis of oHCM patients, septal myectomy was associated with higher in-hospital mortality and periprocedural complications, whereas alcohol septal ablation was associated with more conduction abnormalities requiring device implantation.
SM linked to higher in-hospital mortality and complications than ASA; leaves open optimal patient selection for septal reduction in oHCM.
Background Septal Myectomy (SM) and Alcohol Septal Ablation (ASA) improve symptoms in patients with Hypertrophic Cardiomyopathy with outflow tract obstruction (oHCM). However, outcomes data in this population is predominantly from specialized centers. Methods The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and −10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with oHCM who underwent SM vs. ASA. A p-value <0.001 was considered statistically significant. Results We identified 17,245 patients with oHCM who underwent septal reduction therapies, of whom 62.5% underwent SM, and 37.5% underwent ASA. Patients who underwent SM had higher all-cause mortality (OR:2.2 [1.7-2.9]), post-procedure ischemic stroke (OR: 2.4 [1.8-3.2]), acute kidney injury (OR: 1.9 [1.7-2.2]), vascular complications (OR: 4 [2.8-5.7]), ventricular septal defect (OR: 4.6 [3.5-6.1]), cardiogenic shock (OR: 2 [1.5-2.6]), sepsis (OR: 5.2 [3.3-8.1]), and left bundle branch block (OR: 3.2 [2.8-3.7]), compared to ASA. Patients who underwent ASA had higher post-procedure complete heart block (OR: 1.2 [1.1-1.4]), 2nd-degree AV Block (OR: 2 [1.4-3]), right bundle branch block (OR: 6.4 [5.3-7.8]), ventricular tachycardia (OR:2 [1.8-2.3]), supraventricular tachycardia (OR: 1.4 [1.2-1.7]), and more commonly required pacemaker (OR: 1.4 [1.2-1.6]) or implantable cardioverter-defibrillator insertion (OR: 1.3 [1.1-1.5]) (p<0.001 for all) compared to SM. Conclusions This nationwide analysis evidenced that patients undergoing SM had higher in-hospital mortality and periprocedural complications than ASA; however, those undergoing ASA had more post-procedure conduction abnormalities and pacemaker or ICD implantation. The implications of these findings warrant further investigation regarding patient selection strategies for these therapies.
No takes yet. Share an insight, caveat, or question.
Inestroza et al. (2023) conducted an observational in Hypertrophic Cardiomyopathy with outflow tract obstruction (n=17,245). Septal Myectomy vs. Alcohol Septal Ablation was evaluated on All-cause in-hospital mortality (aOR 2.2, 95% CI 1.7-2.9, p=<0.001). Septal myectomy was associated with higher in-hospital all-cause mortality (aOR 2.2) and periprocedural complications compared to alcohol septal ablation in obstructive hypertrophic cardiomyopathy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: