Key result
Concurrent CABG during septal myectomy is linked to an ~8-fold higher long-term CV mortality in HOCM.
Why the study?
The mid-term outcomes of patients with hypertrophic obstructive cardiomyopathy undergoing simultaneous coronary artery bypass graft surgery and septal myectomy were unclear.
Does the presence of CAD requiring simultaneous CABG worsen cardiovascular outcomes in patients with HOCM undergoing septal myectomy compared to those without CAD?
Case-Control (n=220)
Does the presence of CAD requiring simultaneous CABG worsen cardiovascular outcomes in patients with HOCM undergoing septal myectomy compared to those without CAD?
Patients with HOCM and CAD undergoing simultaneous CABG and septal myectomy have significantly higher cardiovascular mortality and events compared to HOCM patients without CAD undergoing septal myectomy alone.
CAD requiring CABG was associated with higher CV mortality after HOCM myectomy; leaves open whether CAD independently drives risk or reflects confounding.
BACKGROUND: The mid-term outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing coronary artery bypass graft (CABG) is unclear. MATERIALS AND METHODS: We studied 44 patients with HOCM and coronary artery disease (CAD) who underwent septal myectomy and CABG) between 2011 and 2017. The control group was matched in a ratio of 4:1 based on age, sex, body mass index, hypertension, and chest pain. RESULTS: Compared to patients without CAD, patients with CAD had a higher long-term cardiovascular mortality rate (0.6% vs 6.8%, P = 0.03; hazard ratio [HR] = 8.16, 95% confidence interval [CI]: 1.27-74.48, P = 0.03). In addition, 10 out of 176 (5.7%) patients without CAD and nine out of 44 (20.5%) patients with CAD achieved the secondary endpoints (progressive heart failure, unexplained syncope, stroke, atrial fibrillation, and myocardial infarction) (HR = 2.89, 95%CI: 1.03-8.12, P = 0.04). The 5-year survival rate and cardiovascular event-free survival rate were significantly higher in patients without CAD than in those with CAD (97.4% vs 93.9%, P = 0.03; 89.2% vs 80.1%; P = 0.04). In the multivariate analysis, presence of CAD, New York Heart Association class, and left atrial diameter were predictors of combined cardiovascular events when adjusted for age and male sex. CONCLUSIONS: The cardiovascular death and cardiovascular events are significantly increased in patients with HOCM and CAD who underwent CABG at the time of septal myectomy.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2019) conducted a case-control in Hypertrophic obstructive cardiomyopathy (HOCM) (n=220). Concurrent coronary artery disease requiring CABG vs. Patients without CAD was evaluated on Long-term cardiovascular mortality (HR 8.16, 95% CI 1.27-74.48, p=0.03). In patients with HOCM undergoing septal myectomy, concurrent CAD requiring CABG was associated with higher long-term cardiovascular mortality (6.8% vs 0.6%; HR 8.16, 95% CI 1.27-74.48).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: