BALTIMORE -- Percutaneous alcohol septal ablation appears to be as safe as isolated septal myectomy for patients with hypertrophic obstructive cardiomyopathy, across clinical settings and regardless of patient volume, a database study showed.
Despite the older age in the ablation patients, they had lower rates of in-hospital mortality (0% versus 5.4%) and new-onset hemodialysis (0% versus 2.5%), with no significant difference in rates of stroke (0.6% versus 0.8%) or placement of permanent pacemakers and implantable cardioverter-defibrillators (18.4% versus 13.6%), according to Srihari Naidu, MD, of Winthrop University Hospital in Mineola, N.Y.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
- Explain that a study of hypertrophic obstructive cardiomyopathy patients, undergoing either alcohol septal ablation or septal myectomy, found reduced in-hospital mortality, new-onset hemodialysis, hospital length of stay, and inflation-adjusted median costs with the ablation procedure.
- Note that the study drew on the PREMIER database, which includes approximately one-sixth of hospitals in the US.
In addition, length of stay (three versus six days) and inflation-adjusted median patient cost ($11,739 versus $30,499) favored the alcohol ablation group (P<0.0001 for both), he reported at the Society for Cardiovascular Angiography and Interventions meeting here.
"Real-world in-hospital data appear to strongly favor alcohol ablation, regardless of whether the comparator group is myectomy without CABG or myectomy without CABG or mitral valve replacement," he said.
"These results ... should better inform clinical decision making, including resource utilization for drug-refractory [hypertrophic obstructive cardiomyopathy] patients in need of invasive therapy."
Steven Bailey, MD, a cardiologist at the University of Texas Health Science Center in San Antonio, commented that "in the cardiology community in general, there really is a lot of uncertainty about what the best therapies for these patients are."
There are not enough robust databases from single centers to help clarify the issue and randomized trials are unlikely because of a variety of confounding variables, Bailey told 麻豆传媒.
Naidu's study "was important because it did look at national trends in terms of therapy," said Bailey, who moderated the SCAI session.
"In the case of percutaneous procedures, there does not seem to be a major morbidity or mortality associated with doing them," he said.
Recent data from larger centers indicating a surgical mortality rate of less than 1% have raised questions about whether there is any advantage to alcohol septal ablation, which carries risks of complete heart block and procedural complication, over the more established myectomy, according to Naidu.
To look at the two procedures using national data, Naidu turned to the PREMIER Perspective database that includes information on about one-sixth of U.S. hospitals.
He searched for patients who underwent either alcohol septal ablation or isolated septal myectomy (without concomitant CABG) from Jan. 1, 2000, to June 30, 2010, identifying 242 who underwent myectomy at 97 hospitals and 163 who underwent ablation at 37 hospitals.
On average, patients who underwent alcohol septal ablation were older (60 versus 54, P<0.01), although other baseline characteristics were similar.
Despite the age difference, ablation was associated with a lower rate of mortality and new-onset hemodialysis, a shorter hospital stay, and lower costs.
There was a higher rate of mitral valve replacement in the myectomy group (27.7% versus 0%, P<0.0001), but after excluding patients who had valve replacement, there was still an advantage for mortality, length of stay, and cost in the ablation group.
Bailey said that the study raises some questions that need to be investigated including how patients were selected for one treatment or the other. This would provide a true comparison of the relative safety of alcohol septal ablation and isolated septal myectomy, he said.
Disclosures
Naidu reported that he had no conflicts of interest. His co-author is an employee of The Medicines Company.
Primary Source
Society for Cardiovascular Angiography and Interventions
Source Reference: Naidu S, et al "Comparative in-hospital safety and cost of alcohol septal ablation versus isolated surgical myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Insights from the multicenter PREMIER database" SCAI 2011; Abstract O-008.