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

IF 6.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Mayo Clinic proceedings Pub Date : 2024-11-12 DOI:10.1016/j.mayocp.2024.05.026

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

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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.

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肥厚型心肌病室间隔置换术后临床疗效的性别差异。

目的评估接受房间隔肌肉切除术和酒精房间隔消融术的肥厚型心肌病（HCM）患者短期和长期预后的性别差异：这项回顾性队列研究使用了 TriNetX 研究数据库中的电子健康记录数据。采用《国际疾病分类》第九版和第十版的诊断和手术代码来识别 2002 年 1 月至 2023 年 3 月期间在美国接受房间隔肌切除术和酒精性房间隔消融术的 HCM 患者。研究结果为长期死亡率和术后并发症（结果：在 11,680 名成人（32.0% 为女性；中位年龄为 63 [四分位间范围为 54 至 71]岁）中，分别有 1916 人（16.4%）和 9764 人（83.6%）接受了房间隔黏膜切除术和酒精性房间隔消融术。在接受房间隔肌肉切除术的患者中，性别与短期（调整后危险比 [HRadj]，1.57 [0.64 至 3.87]）和长期（HRadj，1.05 [0.87 至 1.26]）死亡率无关。与女性患者相比，男性患者在接受隔膜切除术后发生急性肾衰竭的风险更高（HRadj，1.69 [1.33 至 2.15]）。在接受酒精房间隔消融术的患者中，男性患者（HRadj，1.07 [0.99 至 1.16]）的长期死亡风险与女性患者相似。与女性患者相比，男性患者在酒精中隔消融术后发生急性肾衰竭的风险更高（HRadj，1.23 [1.02 至 1.48]）：这项全国性研究发现，接受房间隔肌肉切除术和酒精房间隔消融术治疗 HCM 的男性和女性患者的短期和长期死亡风险相似。临床表现中的性别差异不应妨碍对房间隔减容疗法的考虑。

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来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

期刊介绍： Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.