Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany.
Can J Cardiol. 2018 Jan;34(1):16-22. doi: 10.1016/j.cjca.2017.10.020.
The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure.
We retrospectively evaluated 1310 patients with symptomatic obstructive hypertrophic cardiomyopathy who underwent ASA and were divided into 2 groups. The first-50 group consisted of the first consecutive 50 patients treated at each centre, and the over-50 group consisted of patients treated thereafter (patients 51 and above).
In the 30-day follow-up, there was a significant difference in the occurrence of major cardiovascular adverse events (21% in the first-50 group vs 12% in the over-50 group; P < 0.01), which was driven by the occurrence of cardiovascular deaths (2.1% vs 0.4%; P = 0.01) and implanted pacemakers (15% vs 9%; P < 0.01). In the long-term follow-up (5.5 ± 4.1 years), the first-50 group was associated with a significantly higher occurrence of major adverse events (P < 0.01) and higher cardiovascular mortality (P < 0.01). Also, patients in the first-50 group were more likely to self-report dyspnea of New York Heart Association class III/IV (16% vs 10%), to have a left ventricular outflow gradient > 30 mm Hg (16% vs 10%) at the last clinical check-up (P < 0.01 for both), and a probability of repeated septal reduction therapy (P = 0.03).
An institutional experience of > 50 ASA procedures was associated with a lower occurrence of ASA complications, better cardiovascular survival, better hemodynamic and clinical effect, and less need for repeated septal reduction therapy.
美国心脏病学会基金会/美国心脏协会（ACCF/AHA）关于肥厚型心肌病的现行指南指出，机构经验是酒精室间隔消融术（ASA）成功结局和降低并发症发生率的关键决定因素。本研究旨在根据机构经验评估 ASA 的安全性和有效性。
我们回顾性评估了 1310 例有症状梗阻性肥厚型心肌病患者，他们接受了 ASA 治疗，并将其分为 2 组。前 50 组包括每个中心治疗的前 50 例连续患者，超过 50 组包括此后治疗的患者（患者 51 岁及以上）。
在 30 天随访期间，主要心血管不良事件的发生率存在显著差异（前 50 组为 21%，超过 50 组为 12%；P < 0.01），这主要是由心血管死亡（2.1%对 0.4%；P = 0.01）和植入起搏器（15%对 9%；P < 0.01）的发生驱动的。在长期随访（5.5 ± 4.1 年）中，前 50 组发生重大不良事件的几率显著更高（P < 0.01），心血管死亡率更高（P < 0.01）。此外，前 50 组患者更有可能报告纽约心脏协会（NYHA）心功能分级 III/IV 呼吸困难（16%对 10%），在最后一次临床检查时左心室流出道梯度>30mmHg（16%对 10%）（均 P < 0.01），以及需要重复室间隔减少治疗的可能性（P = 0.03）。
ASA 经验超过 50 例与 ASA 并发症发生率较低、心血管生存率更好、血液动力学和临床效果更好以及重复室间隔减少治疗的需求减少相关。
