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(Circulation. 2003;108:2342.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Adverse Prognosis of Patients With Hypertrophic Cardiomyopathy Who Have Epicardial Coronary Artery Disease

Paul Sorajja, MD; Steve R. Ommen, MD; Rick A. Nishimura, MD; Bernard J. Gersh, MB ChB, DPhil; Peter B. Berger, MD; A. Jamil Tajik, MD

From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn.

Correspondence to Steve R. Ommen, MD, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. E-mail ommen.steve{at}mayo.edu

Received February 12, 2003; de novo received June 25, 2003; revision received August 12, 2003; accepted August 12, 2003.

Background— Adult patients with hypertrophic cardiomyopathy (HCM) may develop concomitant atherosclerotic coronary artery disease (CAD). There is a paucity of data on the clinical outcomes of HCM patients who have CAD.

Methods and Results— We examined the outcome of 433 adult patients with HCM according to the presence and severity of CAD. All patients were aged 21 years, had a left ventricular ejection fraction of 50%, and were without a history of prior surgical revascularization (mean age, 63 years; 212 men). Compared with HCM patients with mild-to-moderate or no CAD, those with severe CAD demonstrated markedly reduced survival. Ten-year overall survival was 46.1%, 70.5%, and 77.1% for patients with severe, mild-to-moderate, and no CAD, respectively (unadjusted P=0.0001; adjusted P=0.0006). For the end point of cardiac death, this survival was 62.3%, 81.0%, and 80.9% (unadjusted P=0.009; adjusted P=0.004). For the end point of sudden cardiac death, this survival was 77.4%, 93.2%, and 90.3% (unadjusted P=0.01; adjusted P=0.01). The presence of severe CAD also was highly predictive of these events (risk ratio for respective event: 2.31, 2.15, and 2.77) in multivariate models that additionally identified age, prior stroke, hyperlipidemia, and atrial fibrillation as significant covariates.

Conclusions— Among adult patients with HCM who undergo coronary angiography, those who have concomitant severe CAD are at increased risk of death. This risk far exceeds historical death rates of CAD patients with normal left ventricular function.

Key Words: coronary disease • cardiomyopathy • hypertrophy • prognosis

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