Septal Myectomy or Alcohol Ablation for Hypertrophic Cardiomyopathy: A Nationwide Inpatient Sample (NIS) Database Analysis.

ABSTRACT

BACKGROUND: Comparison of the real-world cohort on the relative safety of alcohol septal ablation (ASA) vs. septal myectomy (SM) for the management of hypertrophic cardiomyopathy (HCM) has been lacking. METHODS: The National Inpatient Sample (NIS) (2012-2019) was used to select all cases of HCM. The safety of ASA vs. SM was compared using a onemany propensity score matched (PSM) analysis. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were computed. RESULTS: A total of 6208 HCM patients (ASA 3106 vs. SM 3102) were included using a PSM analysis. Post-procedural bleeding (aOR 0.18, 95 % CI 0.11-0.32, p < 0.0001) and the need for an intra-aortic balloon pump (aOR 0.51, 95 % CI, 0.28-0.96, p = 0.037) were significantly lower while permanent pacemaker (PPM) implantation was significantly higher in ASA group as compared with SM group (aOR 1.72, 95 % CI, 1.43-2.06, p < 0.0001). The total in-hospital mean adjusted cost and length of stay were also significantly lower in the ASA group. However, there were no significant differences in adjusted odds of all-cause mortality (aOR 0.91, 95 % CI 0.62-1.33, p = 0.61), stroke (aOR 0.91, 95 % CI, 0.59-1.4, p = 0.66), and major bleeding (aOR 1.0, 95 % CI 7.8-1.29, p = 0.99) between the two comparison groups. CONCLUSION: In patients with hypertrophic cardiomyopathy, alcohol septal ablation appears to be an acceptable alternative to septal myectomy due to a lower risk of post-procedural bleeding and the need for an intra-aortic balloon pump. However, ASA confers a higher risk of PPM placement.