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Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: Outcomes in young, middle‐aged, and elderly patients
Author(s) -
Leonardi Robert A.,
Townsend Jacob C.,
Patel Chetan A.,
Wolf Bethany J.,
Todoran Thomas M.,
Powers Eric R.,
Steinberg Daniel H.,
Fernandes Valerian L.,
Nielsen Christopher D.
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24643
Subject(s) - medicine , alcohol septal ablation , comorbidity , young adult , hypertrophic cardiomyopathy , middle age , cardiomyopathy , complication , cardiology , refractory (planetary science) , population , obstructive cardiomyopathy , pediatrics , surgery , heart failure , physics , environmental health , astrobiology
Objectives We compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle‐aged, and elderly patients. Background Intersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA. Methods Data for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age. Results Young (<45 years), middle‐aged (45–64 years), and elderly (≥65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow‐up ( P < 0.001 for before and after comparisons; P = NS for intergroup comparisons). Complication rates were similar for young and middle‐aged patients but higher for elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P ≤ 0.016 for elderly vs. others). Mortality rates for young and middle‐aged patients were lower than for elderly patients, but the differences were not statistically significant. Conclusions Patients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates. © 2012 Wiley Periodicals, Inc.