Alcohol Septal Ablation Associated With Increased Long-term Mortality

The rate of long-term mortality among patients with obstructive hypertrophic cardiomyopathy was greater in those who underwent septal reduction by alcohol septal ablation (ASA) compared with septal myectomy, according to study findings published in the Journal of the American College of Cardiology.

Researchers looked at outcomes for 3859 patients who underwent ASA or septal myectomy between 1998 and 2019 at specialized hypertrophic cardiomyopathy centers at the Mayo Clinic, Rochester, Minnesota; Tufts Medical Center, Boston, Massachusetts; and Fuwai Hospital, Beijing, China.

“Each participating center in the present study is highly experienced in both septal myectomy (cumulative volume: >300) and ASA (cumulative volume: >150),” wrote study authors.

Most patients in the cohort (84.8%) underwent septal myectomy. Those who underwent ASA (15.2%) had smaller septal thickness and were significantly older (median age 63.0 years compared with 53.7 years for septal myectomy). They also had more comorbidities, including renal failure, diabetes, hypertension, and coronary artery disease.

The 10-year all-cause mortality rate was 26.1% in the ASA group, compared with 8.2% in the septal myectomy group, according to the study. Mortality remained increased in the ASA group even after researchers adjusted for age, sex, and comorbidities, with a hazard ratio of 1.68.

“This impact on survival is independent of other known factors,” wrote researchers, “but may be influenced by unmeasured confounding patient characteristics.”

Reference:
Cui H, Schaff HV, Wang S, et al. Survival following alcohol septal ablation or septal myectomy for patients with obstructive hypertrophic cardiomyopathy. J Am Coll of Cardiol. 2022;79(17):1647-1655. doi:10.1016/j.jacc.2022.02.032