Department of Cardiology, Henry Ford Hospital, Detroit, Michigan; Universidad de San Martín de Porres, Facultad de Medicina, Centro de Investigaciónde EpidemiologíaClínica y MedicinaBasada en la Evidencia Lima, Peru.
Department of Cardiology, Henry Ford Hospital, Detroit, Michigan.
Am J Cardiol. 2020 Jul 15;127:128-134. doi: 10.1016/j.amjcard.2020.04.018. Epub 2020 Apr 22.
Alcohol septal ablation (ASA) and septal myectomy (SM) are therapeutic interventions for patients with hypertrophic cardiomyopathy (HC) who remain symptomatic despite medical treatment. Outcomes for both interventions in age groups ≤65 versus >65 years are scarce. We queried the National Readmission Database for adult patients undergoing either SM or ASA between 2010 and 2015 for HC. Patients were divided into 2 age-groups (≤65-years and >65-years). We aimed to compare the in-hospital mortality, complication rates, and resource utilization for each procedure between the 2 age-groups. We identified 4,358 patients with HC who underwent intervention, of which 2,113 were treated with SM and 2,245 with ASA. In-hospital mortality was 6-times higher in patients ≤65 years old who underwent SM compared with ASA (1.5% vs 0.3% odds ratio 6.2; p = 0.04); and 4-times higher in patients >65 years treated with SM compared with ASA (6.7% vs 1.7% odds ratio 4.29; p = 0.04). Blood transfusion rates and stroke were higher in patients undergoing SM, regardless of their age-group. Length of hospital stay was lower in the ASA group (3 days vs 6 days for both age groups, p <0.001) as well as median hospital costs (≤65 years old: $15,474 vs $31.531; and >65 years old: $16,672 vs $36,042, p <0.001). In conclusion, patients with HC treated with ASA had significantly lower in-hospital mortality, complications rates, length of hospital stay, and hospital costs compared with patients undergoing SM at any age.
酒精室间隔消融术（ASA）和室间隔心肌切除术（SM）是对肥厚型心肌病（HC）患者的治疗干预措施，这些患者尽管接受了药物治疗，但仍有症状。年龄在 65 岁以下和 65 岁以上的患者接受这两种干预措施的结果都很少。我们在 2010 年至 2015 年期间，从国家再入院数据库中查询了接受 SM 或 ASA 治疗的成年 HC 患者。患者被分为 2 个年龄组（≤65 岁和>65 岁）。我们旨在比较这两个年龄组之间的每种手术的住院死亡率、并发症发生率和资源利用率。我们确定了 4358 名接受介入治疗的 HC 患者，其中 2113 名接受 SM 治疗，2245 名接受 ASA 治疗。与 ASA 相比，接受 SM 治疗的≤65 岁患者的住院死亡率高 6 倍（优势比 6.2；p=0.04）；与 ASA 相比，接受 SM 治疗的>65 岁患者的住院死亡率高 4 倍（优势比 4.29；p=0.04）。无论年龄组如何，接受 SM 治疗的患者的输血率和卒中率都较高。ASA 组的住院时间较短（≤65 岁：3 天与 6 天；>65 岁：3 天与 6 天，均 p<0.001），中位住院费用也较低（≤65 岁：15474 美元与 31531 美元；>65 岁：16672 美元与 36042 美元，均 p<0.001）。总之，与任何年龄接受 SM 治疗的患者相比，接受 ASA 治疗的 HC 患者的住院死亡率、并发症发生率、住院时间和住院费用显著降低。
