Morita Sae X, Zhao Yanling, Hasegawa Kohei, Fifer Michael A, Maurer Mathew S, Reilly Muredach P, Takayama Hiroo, Shimada Yuichi J
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center.
Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center.
Int Heart J. 2021 Sep 30;62(5):1035-1041. doi: 10.1536/ihj.21-095. Epub 2021 Sep 17.
Septal reduction therapy (SRT) -i.e. septal myectomy and alcohol septal ablation-has been performed to treat medically refractory hypertrophic cardiomyopathy (HCM) for decades. However, it is largely unknown whether SRT prevents HCM-related cardiovascular events or death. The objective was to examine the effects of SRT on acute cardiovascular events and all-cause mortality in HCM. We performed a propensity score (PS) -matched study using databases that capture all hospitalizations and outpatient visits in New York state. We identified patients with HCM who underwent SRT between 2007 and 2014 (i.e. the SRT group) and those who had never had SRT but had at least one hospitalization for HCM during the same period (i.e. the control group). We performed PS matching at a 1:1 ratio. The primary outcome was a composite of acute cardiovascular events and all-cause mortality during 0-180 days and 181-360 days. The secondary outcome was 180- and 360-day all-cause mortality. We included 846 patients with HCM (423 PS-matched pairs). Patients who underwent SRT had a lower risk of the primary outcome event (0-180 days: odds ratio [OR], 0.54; 95% confidence intervals (CI), 0.37-0.80; P = 0.002 and 181-360 days: OR, 0.33; 95% CI, 0.22-0.51; P < 0.0001). Furthermore, the risk of all-cause mortality was lower at 180 days (OR, 0.37; 95% CI, 0.22-0.63; P = 0.0003) and 360 days post-SRT (OR, 0.32; 95% CI, 0.20-0.51; P < 0.0001). In conclusion, our PS-matched study using population-based datasets demonstrated that SRT was associated with a reduced risk of a composite of acute cardiovascular events and all-cause mortality in HCM during the first post-SRT year.
几十年来，一直采用间隔减容疗法（SRT），即间隔肌切除术和酒精间隔消融术，来治疗药物难治性肥厚型心肌病（HCM）。然而，SRT能否预防HCM相关的心血管事件或死亡在很大程度上尚不清楚。目的是研究SRT对HCM患者急性心血管事件和全因死亡率的影响。我们使用记录纽约州所有住院和门诊就诊情况的数据库进行了一项倾向评分（PS）匹配研究。我们确定了2007年至2014年间接受SRT的HCM患者（即SRT组）以及同期从未接受SRT但因HCM至少住院一次的患者（即对照组）。我们以1:1的比例进行PS匹配。主要结局是0至180天和181至360天期间急性心血管事件和全因死亡率的综合指标。次要结局是180天和360天的全因死亡率。我们纳入了846例HCM患者（423对PS匹配对）。接受SRT的患者发生主要结局事件的风险较低（0至180天：比值比[OR]，0.54；95%置信区间[CI]，0.37至0.80；P = 0.002；181至360天：OR，0.33；95%CI，0.22至0.51；P < 0.0001）。此外，SRT后180天（OR，0.37；95%CI，0.22至0.63；P = 0.0003）和360天（OR，0.32；95%CI，0.20至0.51；P < 0.0001）全因死亡风险较低。总之，我们使用基于人群数据集的PS匹配研究表明，SRT与SRT后第一年HCM患者急性心血管事件和全因死亡率综合指标风险降低相关。
