Sex-Associated Differences in Clinical Outcomes After Septal Reduction Therapies in Hypertrophic Cardiomyopathy

Nirav Patel; Naman S Shetty; Akhil Pampana; Mokshad Gaonkar; Nehal Vekariya; Peng Li; Anjali T Owens; Christopher Semsarian; Garima Arora; Pankaj Arora

doi:10.1016/j.mayocp.2024.05.026

Sex-Associated Differences in Clinical Outcomes After Septal Reduction Therapies in Hypertrophic Cardiomyopathy

Mayo Clin Proc. 2024 Dec;99(12):1933-1944. doi: 10.1016/j.mayocp.2024.05.026. Epub 2024 Nov 12.

Authors

Affiliations

¹ Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham.
² School of Nursing, University of Alabama at Birmingham, Birmingham.
³ Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.
⁴ Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL. Electronic address: parora@uabmc.edu.

PMID: 39530964
DOI: 10.1016/j.mayocp.2024.05.026

Abstract

Objective: To evaluate sex-associated differences in the short- and long-term outcomes of patients with hypertrophic cardiomyopathy (HCM) undergoing septal myectomy and alcohol septal ablation.

Methods: This retrospective cohort study used electronic health record data from the TriNetX research database. International Classification of Diseases, Ninth Revision and Tenth Revision diagnosis and procedure codes were used to identify patients with HCM who underwent septal myectomy and alcohol septal ablation in the United States between January 2002 and March 2023. The outcomes were long-term mortality and postprocedural complications (<30 days), including death, stroke, major bleeding, and renal failure. Multivariable adjusted Cox models were used to assess the association of outcomes by sex, taking female patients as reference.

Results: Of 11,680 adults (32.0% female; median age, 63 [interquartile range, 54 to 71] years), 1916 (16.4%) and 9764 (83.6%) underwent septal myectomy and alcohol septal ablation, respectively. For those who underwent septal myectomy, sex was not associated with short-term (adjusted hazard ratio [HR_adj], 1.57 [0.64 to 3.87]) and long-term (HR_adj, 1.05 [0.87 to 1.26]) mortality. Male patients had a higher risk of acute renal failure compared with female patients after septal myectomy (HR_adj, 1.69 [1.33 to 2.15]). Of those who underwent alcohol septal ablation, male patients (HR_adj, 1.07 [0.99 to 1.16]) had a similar risk of long-term mortality to that of female patients. Compared with female patients, the risk of acute renal failure was higher in male patients (HR_adj, 1.23 [1.02 to 1.48]) after alcohol septal ablation.

Conclusion: This nationwide study found that the risk of short- and long-term mortality was similar for male and female patients undergoing septal myectomy and alcohol septal ablation for HCM. The sex-based differences in the clinical presentation should not prevent consideration of septal reduction therapies.

MeSH terms

Ablation Techniques / methods
Aged
Cardiac Surgical Procedures / adverse effects
Cardiac Surgical Procedures / methods
Cardiomyopathy, Hypertrophic* / mortality
Cardiomyopathy, Hypertrophic* / surgery
Cardiomyopathy, Hypertrophic* / therapy
Ethanol / adverse effects
Ethanol / therapeutic use
Female
Heart Septum* / surgery
Humans
Male
Middle Aged
Postoperative Complications / epidemiology
Postoperative Complications / mortality
Retrospective Studies
Sex Factors
Treatment Outcome
United States / epidemiology

Substances

Ethanol