title: Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy.
abstract: BACKGROUND
  The impact of alcohol septal ablation (ASA) on the survival of patients with drug-refractory obstructive hypertrophic cardiomyopathy (HCM) remains unresolved. The aim of this study was to compare survival after ASA vs. conservative therapy.
  
  
  METHODS
  We studied a consecutive cohort of 274 patients with severe drug-refractory obstructive HCM, 229 in ASA group and 45 in conservative group. The primary endpoint was a composite of all-cause mortality and aborted cardiac arrest.
  
  
  RESULTS
  With a median follow-up of 4.3 years, primary endpoint occurred in 13 (5.7%) patients in the ASA group, and 8 (17.8%) patients in the conservative group. The 5- and 10-year survival free from primary endpoint of the ASA group (94.5% and 93.0%, respectively) was significantly better than that of the conservative group (78.3% and 72.2%, respectively, log-rank p = 0.009). Independent determinants of primary endpoint were ASA therapy (hazard ratio [HR] 0.22; 95% confidence interval [CI] 0.08-0.60; p = 0.003) and maximal septal thickness (HR 1.14; 95% CI 1.03-1.27; p = 0.011).
  
  
  CONCLUSIONS
  In patients with severe drug-refractory obstructive HCM, survival after ASA is favorable and better than that of conservative therapy. ASA seems to improve survival.
authors.forename: Yin-Jian
authors.initials: YJ
authors.lastname: Yang
authors.affiliation: Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. fancm2004@126.com.
authors.forename: Chao-Mei
authors.initials: CM
authors.lastname: Fan
authors.forename: Jin-Qing
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Shu-Bin
authors.initials: SB
authors.lastname: Qiao
authors.forename: Feng-Huan
authors.initials: FH
authors.lastname: Hu
authors.forename: Xi-Ying
authors.initials: XY
authors.lastname: Guo
authors.forename: Yi-Shi
authors.initials: YS
authors.lastname: Li
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D002681:China / Q000453:epidemiology; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000187:drug effects*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015552:Injections, Intralesional; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012997:Solvents / Q000008:administration & dosage; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D054088:Ventricular Septum / Q000601:surgery*
chemical_list: D012997:Solvents; D000431:Ethanol
keywords: alcohol septal ablation; conservative therapy; medical therapy; obstructive hypertrophic cardiomyopathy; survival