Mid-term outcomes of simultaneous coronary artery bypass graft surgery and septal myectomy in patients with hypertrophic obstructive cardiomyopathy: A case-controlled study.

BACKGROUND

The mid-term outcome of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing coronary artery bypass graft (CABG) is unclear.

MATERIALS AND

METHODS

We studied 44 patients with HOCM and coronary artery disease (CAD) who underwent septal myectomy and CABG) between 2011 and 2017. The control group was matched in a ratio of 4:1 based on age, sex, body mass index, hypertension, and chest pain.

RESULTS

Compared to patients without CAD, patients with CAD had a higher long-term cardiovascular mortality rate (0.6% vs 6.8%, P = 0.03; hazard ratio [HR] = 8.16, 95% confidence interval [CI]: 1.27-74.48, P = 0.03). In addition, 10 out of 176 (5.7%) patients without CAD and nine out of 44 (20.5%) patients with CAD achieved the secondary endpoints (progressive heart failure, unexplained syncope, stroke, atrial fibrillation, and myocardial infarction) (HR = 2.89, 95%CI: 1.03-8.12, P = 0.04). The 5-year survival rate and cardiovascular event-free survival rate were significantly higher in patients without CAD than in those with CAD (97.4% vs 93.9%, P = 0.03; 89.2% vs 80.1%; P = 0.04). In the multivariate analysis, presence of CAD, New York Heart Association class, and left atrial diameter were predictors of combined cardiovascular events when adjusted for age and male sex.

CONCLUSIONS

The cardiovascular death and cardiovascular events are significantly increased in patients with HOCM and CAD who underwent CABG at the time of septal myectomy.