Abstract 14347: Septal Myectomy is Associated With Worse In-Hospital Outcomes than Alcohol Septal Ablation: Data From the Nationwide Inpatient Sample in the United States, 2003-2011
Introduction: Septal myectomy (SM) and alcohol septal ablation (ASA) are performed for treatment of obstructive hypertrophic cardiomyopathy (HCM). Previous studies comparing ASA and SM are limited to single center registries. We aimed to compare in-hospital outcomes after ASA and SM within a large, national inpatient database.
SM is associated with worse in-hospital outcomes than ASA, particularly in low volume centers.
Methods: We analyzed all patients who were hospitalized for ASA (n=6,386) or SM (n=4,862) in the Nationwide Inpatient Database from 2003 to 2011. Rates of adverse in-hospital events (death, stroke, bleeding, acute renal failure (ARF) and need for permanent pacemaker (PPM)) were examined. Multivariate adjusted analysis was performed to compare outcomes based on tertiles of hospital volume.
Results: Patients undergoing SM were younger, more likely to be female, have anemia, chronic pulmonary disease, diabetes with complications, obesity, peripheral vascular disease and coagulopathy. The incidence of in-hospital death (5.2% vs. 0.7%), post-procedural stroke (1.8% vs. 0%) and ARF (9.7% vs. 3.3%) were greater in SM vs. ASA groups, respectively (all p<0.001). After adjustment for baseline differences and confounders using multivariate propensity-score adjusted logistic regression analysis, SM remained an independent predictor of in-hospital death (OR 5.59, 95%CI 3.71-8.43), stroke (OR 3.81, 95% CI 2.06-7.07) and ARF (OR 2.23, 95% CI 1.77-2.90). In addition, low hospital volume of SM was an independent predictor of mortality (adj OR 3.11, 95% CI 1.98-4.89) and bleeding (adj OR 3.77, 95% CI 2.12-6.70), while low volume of ASA was not independently associated with an increased risk of adverse post-procedural events.
Conclusions: In conclusion, SM was associated with worse in-hospital outcomes, including death, stroke and acute renal failure. Low volume status is associated with worse in-hospital outcomes for SM but not for ASA.
Author Disclosures: P.M. Looser: None. R.V. Swaminathan: None. R.M. Minutello: None. S.C. Wong: None. G. Bergman: None. H. Singh: None. C. Gade: None. K. Charitakis: None. R.K. Kaple: None. D.N. Feldman: Speakers Bureau; Modest; Eli Lilly, Daiichi-Sankyo, Abbott Vascular, Pfizer, Bristol-Myers Squibb. L.K. Kim: None.
- © 2015 by American Heart Association, Inc.