Abstract 4157: Alcohol Septal Ablation is Not Associated With an Increase in Sudden or All-cause Mortality in Obstructive Hypertrophic Cardiomyopathy: A Meta-analysis
For patients with symptomatic, obstructive hypertrophic cardiomyopathy in need of septal reduction therapy, the long-term effects of alcohol septal ablation (ASA) on overall mortality and sudden death have not been well described in comparison to the more established surgical myectomy. We hypothesized that ASA is not associated with higher post-procedural rates of all-cause mortality or sudden death. Systematic reviews for ASA and surgical myectomy were performed with study selection and data extraction by two independent investigators. Comparative data analyses were completed using a random effects model and regression analysis. Kappa for study inclusion was 0.78 for ASA and 0.93 for surgical myectomy. 19 ASA (n=2207 patients) and 7 surgical myectomy studies (n=1760 patients) were included. Median follow-up was much shorter for ASA studies (51 vs. 1618 patient-years, p=0.002). Patients undergoing ASA were older (weighted mean 55 vs. 45 years, p=0.002) but had similar septal thickness (21 vs. 23 mm, p=0.19). Heterogeneity was present for all-cause mortality (p<0.01, I2=63%) but not for sudden death (p=0.15, I2=23%). For ASA and surgical myectomy, unadjusted rates (events/patient-years) of all-cause mortality (0.023 vs. 0.021, p=0.94) and sudden death (0.005 vs. 0.004, p=0.86) were similar. In a regression model showing lower all-cause mortality among patients with younger age (p=0.02) and less hypertrophy (p<0.001), ASA was associated with lower all-cause mortality compared to myectomy (OR 0.42, 95% CI 0.27– 0.65). ASA was not associated with an increase in unadjusted all-cause mortality or sudden death rates in this meta-analysis.