title: Long-term outcomes after medical and invasive treatment in patients with hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  The aim of this study was to determine the long-term outcomes (all-cause mortality and sudden cardiac death [SCD]) after medical therapy, alcohol septal ablation (ASA), and myectomy in patients with hypertrophic cardiomyopathy (HCM).
  
  
  BACKGROUND
  Therapy-resistant obstructive HCM can be treated both surgically and percutaneously. But there is no consensus on the long-term effects of ASA, especially on SCD.
  
  
  METHODS
  This study included 1,047 consecutive patients with HCM (mean age 52 ± 16 years, 61% men) from 3 tertiary referral centers. A total of 690 patients (66%) had left ventricular outflow tract gradients ≥ 30 mm Hg, of whom 124 (12%) were treated medically, 316 (30%) underwent ASA, and 250 (24%) underwent myectomy. Primary endpoints were all-cause mortality and SCD. Kaplan-Meier graphs and Cox regression models were used for statistical analyses.
  
  
  RESULTS
  The mean follow-up period was 7.6 ± 5.3 years. Ten-year survival was similar in medically treated patients (84%), ASA patients (82%), myectomy patients (85%), and patients with nonobstructive HCM (85%) (log-rank p = 0.50). The annual rate of SCD was low after invasive therapy: 1.0%/year in the ASA group and 0.8%/year in the myectomy group. Multivariate analysis demonstrated that the risk for SCD was lower after myectomy compared with the ASA group (hazard ratio: 2.1; 95% confidence interval: 1.0 to 4.4; p = 0.04) and the medical group (hazard ratio: 2.3; 95% confidence interval: 1.0 to 5.2; p = 0.04).
  
  
  CONCLUSIONS
  Patients with obstructive HCM who are treated at referral centers for HCM care have good survival and low SCD risk, similar to that of patients with nonobstructive HCM. The SCD risk of patients after myectomy was lower than after ASA or in the medical group.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Vriesendorp
authors.affiliation: Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium; Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Liebregts
authors.affiliation: Department of Cardiology, Martini Hospital, Groningen, the Netherlands.
authors.forename: Robbert C
authors.initials: RC
authors.lastname: Steggerda
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.affiliation: Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: Ten Cate
authors.affiliation: Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van Cleemput
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: m.michels@erasmusmc.nl.
authors.forename: Michelle
authors.initials: M
authors.lastname: Michels
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000628:therapy*; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012997:Solvents / Q000627:therapeutic use*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000628:therapy
chemical_list: D012997:Solvents; D000431:Ethanol
keywords: alcohol septal ablation; hypertrophic cardiomyopathy; left ventricular outflow tract obstruction; sudden cardiac death; surgical myectomy