Long-Term Outcomes After Medical and Invasive Treatment in Patients With Hypertrophic Cardiomyopathy
JACC: Heart Failure , Volume 2 - Issue 6 p. 630- 636
Objectives: The aim of this study was to determine the long-term outcomes (all-cause mortality and sudden cardiac death [SCD]) after medical therapy, alcohol septal ablation (ASA), and myectomy in patients with hypertrophic cardiomyopathy (HCM). Background: Therapy-resistant obstructive HCM can be treated both surgically and percutaneously. But there isnoconsensus on the long-term effects of ASA, especially on SCD. Methods: This study included 1,047 consecutive patients with HCM (mean age 52 ± 16 years, 61% men) from 3 tertiary referral centers. A total of 690 patients (66%) had left ventricular outflow tract gradients ≥ 30 mmHg, of whom 124(12%) were treated medically, 316 (30%) underwent ASA, and 250 (24%) underwent myectomy. Primary endpoints were all-cause mortality and SCD. Kaplan-Meier graphs and Cox regression models were used for statistical analyses. Results: The mean follow-up period was 7.6 ± 5.3 years. Ten-year survival was similar in medically treated patients (84%), ASA patients (82%), myectomy patients (85%), and patients with nonobstructive HCM (85%) (log-rank p=0.50). The annual rate of SCD was low after invasive therapy: 1.0%/year in the ASA group and 0.8%/year in the myectomy group. Multivariate analysis demonstrated that the risk for SCD was lower after myectomy compared with the ASA group (hazard ratio: 2.1; 95% confidence interval: 1.0 to 4.4; p= 0.04) and the medical group (hazard ratio: 2.3; 95% confidence interval: 1.0 to 5.2; p= 0.04). Conclusions: Patients with obstructive HCM who are treated at referral centers for HCM care have good survival andlow SCD risk, similar to that of patients with nonobstructive HCM. The SCD risk of patients after myectomy was lowerthan after ASA or in the medical group.
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Vriesendorp, P.A, Liebregts, M, Steggerda, R.C, Schinkel, A.F.L, Willems, R.J.L, ten Cate, F.J, … Michels, M. (2014). Long-Term Outcomes After Medical and Invasive Treatment in Patients With Hypertrophic Cardiomyopathy. JACC: Heart Failure, 2(6), 630–636. doi:10.1016/j.jchf.2014.06.012