Age Stratified Analysis for Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation or Septal Myectomy
Lemor A, Villablanca P, Hernandez G, Jain T, Mand R, Eng M, Guerrero M, Wang DD, Palacios I, and O'Neill W. Age Stratified Analysis for Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation or Septal Myectomy. J Am Coll Cardiol 2019; 74(13):B128.
J Am Coll Cardiol
Background: Alcohol septal ablation (ASA) and septal myectomy (SM) are the standard therapeutic interventions for hypertrophic cardiomyopathy (HC). There is limited published data evaluating outcomes of alcohol septal ablation by patient age stratification. Methods: We queried the National Readmission Database for adult patients with HC who underwent either SM or ASA between 2010 and 2015 in the United States. We then divide them into 2 groups (age ≤65 and >65 years). We aimed to compare in-hospital mortality and complication rates for each procedure using age 65 years to divide 2 age groups. Results: A total of 5,021 patients with HC were identified in the study period; 2,763 underwent SM and 2,258 ASA. In both study groups, patients age >65 years were predominantly women, with a higher frequency of hypertension, dyslipidemia, and known coronary artery disease, but less incidence of obesity and smoking. The odds of in-hospital mortality was almost 8 times higher in patients ≤65 years age undergoing SM when compared with ASA (2.1% vs. 0.3%; odds ratio [OR]: 7.7; p = 0.01); those older than 65 years experienced a 4-fold increase risk of in-hospital mortality with SM (8.2% vs. 1.7%; OR: 4.2; p = 0.007). Similarly, rates of acute kidney injury, blood transfusion, and ischemic stroke were significantly higher in patients undergoing SM, regardless of the age group (Table 1). There were no significant differences in rates of pacemaker implantation or major bleeding events among age groups. Length of stay was significantly lower in the ASA group across both age groups in comparison to SM (3 days vs. 6 days; p < 0.001), as well as median hospital costs (age ≤65 years: $15,509 vs. $33,882; p < 0.001; and age >65 years: $16,753 vs. $43,426; p < 0.001) (Figure). [Figure presented] Conclusion: In patients with HC, those undergoing ASA had significantly lower in-hospital mortality, complication rates, LOS, and hospital cost without an increase rate of PPM when compared with patients who had SM. This study suggests that ASA is an effective and safe procedure for HC among adult populations.