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Kimmelstiel C, Zisa DC, Kuttab JS, Wells S, Udelson JE, Wessler BS, Rastegar H, Kapur NK, Weintraub AR, Maron BJ, Maron MS, Rowin EJ. Guideline-Based Referral for Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy Is Associated With Excellent Clinical Outcomes. Circ Cardiovasc Interv 2019; 12:e007673. [PMID: 31296080 DOI: 10.1161/circinterventions.118.007673] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The outcome of medically refractory patients with obstructive hypertrophic cardiomyopathy treated according to the American College of Cardiology/American Heart Association consensus guideline recommendations is not known. The objectives of this study were to define the short- and long-term outcomes of medically refractory obstructive hypertrophic cardiomyopathy patients undergoing alcohol septal ablation (ASA) and surgical septal myectomy (SM) with patient management in accordance with these consensus guidelines, as well as to quantify procedural risk and burden of comorbid conditions at the time of treatment. METHODS AND RESULTS Patients with obstructive hypertrophic cardiomyopathy referred for either ASA or SM from 2004 to 2015 were followed for the primary end point of short- and long-term mortality and compared with respective age- and sex-matched US populations. Of 477 consecutive severely symptomatic patients, 99 underwent ASA and 378 SM. Compared with SM, ASA patients were older ( P<0.001), had a higher burden of comorbid conditions ( P<0.01), and significantly higher predicted surgical mortality ( P<0.005). Procedure-related mortality was 0.3% and similarly low in both groups (0% in ASA and 0.8% in SM). Over 4.0±2.9 years of follow-up, 95% of patients had substantial improvement in heart failure symptoms to New York Heart Association class I/II (96% in SM and 90% in ASA). Long-term mortality was similar between the 2 groups with no difference compared with age- and sex-matched US populations. CONCLUSIONS Guideline-based referral for ASA and SM leads to excellent outcomes with low procedural mortality, excellent long-term survival, and improvement in symptoms. These outcomes occur in ASA patients despite being an older cohort with significantly more comorbidities.
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Affiliation(s)
- Carey Kimmelstiel
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - David C Zisa
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Johny S Kuttab
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Sophie Wells
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - James E Udelson
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Benjamin S Wessler
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Hassan Rastegar
- Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Division of Cardiothoracic Surgery (H.R.), Tufts Medical Center, Boston, MA
| | - Navin K Kapur
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Andrew R Weintraub
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Barry J Maron
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Martin S Maron
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
| | - Ethan J Rowin
- Division of Cardiology (C.K., D.C.Z., J.S.K., S.W., J.E.U., B.S.W., N.K.K., A.R.W., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA.,Hypertrophic Cardiomyopathy Center (C.K., H.R., B.J.M., M.S.M., E.J.R.), Tufts Medical Center, Boston, MA
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