Among adult patients with hypertrophic cardiomyopathy, severe coronary artery disease significantly reduced 10-year overall survival compared to no CAD (46.1% vs 77.1%; adjusted P=0.0006).
Cohort (n=433)
Does the presence of severe coronary artery disease worsen survival in adult patients with hypertrophic cardiomyopathy?
The presence of severe concomitant coronary artery disease in patients with hypertrophic cardiomyopathy is associated with a markedly increased risk of overall, cardiac, and sudden cardiac mortality.
Effect estimate: RR 2.31
Absolute Event Rate: 46.1% vs 77.1%
p-value: p=0.0006
Background— Adult patients with hypertrophic cardiomyopathy (HCM) may develop concomitant atherosclerotic coronary artery disease (CAD). There is a paucity of data on the clinical outcomes of HCM patients who have CAD. Methods and Results— We examined the outcome of 433 adult patients with HCM according to the presence and severity of CAD. All patients were aged ≥21 years, had a left ventricular ejection fraction of ≥50%, and were without a history of prior surgical revascularization (mean age, 63 years; 212 men). Compared with HCM patients with mild-to-moderate or no CAD, those with severe CAD demonstrated markedly reduced survival. Ten-year overall survival was 46.1%, 70.5%, and 77.1% for patients with severe, mild-to-moderate, and no CAD, respectively (unadjusted P =0.0001; adjusted P =0.0006). For the end point of cardiac death, this survival was 62.3%, 81.0%, and 80.9% (unadjusted P =0.009; adjusted P =0.004). For the end point of sudden cardiac death, this survival was 77.4%, 93.2%, and 90.3% (unadjusted P =0.01; adjusted P =0.01). The presence of severe CAD also was highly predictive of these events (risk ratio for respective event: 2.31, 2.15, and 2.77) in multivariate models that additionally identified age, prior stroke, hyperlipidemia, and atrial fibrillation as significant covariates. Conclusions— Among adult patients with HCM who undergo coronary angiography, those who have concomitant severe CAD are at increased risk of death. This risk far exceeds historical death rates of CAD patients with normal left ventricular function.
Sorajja et al. (Tue,) conducted a cohort in Hypertrophic cardiomyopathy (n=433). Severe coronary artery disease vs. Mild-to-moderate or no coronary artery disease was evaluated on 10-year overall survival (RR 2.31, p=0.0006). Among adult patients with hypertrophic cardiomyopathy, severe coronary artery disease significantly reduced 10-year overall survival compared to no CAD (46.1% vs 77.1%; adjusted P=0.0006).