Impact of Gender on Clinical Outcomes of Septal Myectomy Versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy in the United States
Jain T, Lemor A, Villablanca P, Wang DD, Guerrero M, Palacios I, Frisoli T, Eng M, and O'Neill W. Impact of Gender on Clinical Outcomes of Septal Myectomy Versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy in the United States. J Am Coll Cardiol 2019; 74(13):B127.
J Am Coll Cardiol
Background: Septal myectomy (SM) is considered to be the preferred invasive treatment strategy for obstructive hypertrophic cardiomyopathy (HCM) compared with alcohol septal ablation (ASA). However, there is no comparative data on impact of sex on clinical outcomes between the 2 strategies. Methods: We queried the U.S. National Readmission Database to identify adult patients with HCM who underwent SM or ASA between 2010 and 2015. We compared the 2 procedures based on sex for in-hospital mortality and other short-term outcomes. Results: Of a total of 5,020 HCM patients, 2,763 underwent SM of which 1,511 were women, and 2,258 had ASA of which 1,325 were women. The odds of in-hospital mortality was 3.5× higher in female patients undergoing SM when compared with ASA (3.4% vs. 1.3%; odds ratio [OR]: 3.4; p = 0.014); men had an almost 11-fold increased risk of in-hospital mortality with SM (3.3% vs. 0.4%; OR: 10.8; p = 0.011). Rates of acute kidney injury, blood transfusion, and ischemic stroke were significantly higher in both sexes undergoing SM. There was no difference in rates of pacemaker implantation both in women undergoing SM (10.6% vs. 14%; p = 0.93) and men (9.2% vs. 8.3%; p = 0.37) when compared with those undergoing ASA. Length of stay was significantly lower with ASA in both women and men in comparison to SM (3 days vs. 7 days; p < 0.001 and 2 days vs. 6 days; p < 0.001), respectively. Total hospital cost was also lower in the ASA group (women: $16,465 vs. $35,024; p < 0.001; and men: $15,661 vs. $36,754; p < 0.001). Male ASA patients had lower 30-day readmission compared with male SM patients (5% vs. 12.7%; OR: 2.6; p = 0.007) (Table). [Figure presented] Conclusion: In both female and male HCM patients, ASA was associated with lower in-hospital mortality, complication rates, length of stay, and hospital cost with no difference in rate of pacemaker implantation when compared with SM.