Severe coronary artery disease is associated with disproportionately increased risks of death in patients with hypertrophic cardiomyopathy. There is a paucity of data on the long-term effect of coronary revascularization at the time of myectomy. Between January 1, 1961, and October 31, 2017, 2913 adult patients underwent transaortic septal myectomy at Mayo Clinic. Concomitant coronary artery bypass grafting (CABG) was performed in 246 (8.4%). We compared baseline characteristics of patients who underwent septal myectomy with and without CABG and assessed the effect of surgical revascularization on the risk of all-cause mortality. Patients who underwent concomitant CABG were older (median [interquartile range], 66.3 [59.8-72.1] years vs 54.4 [43.5-64.8] years; P<.0001) and more likely to be male (63.0% vs 54.2%; P=.008) than those who did not undergo coronary revascularization at operation. There was no significant difference in preoperative left ventricular outflow tract gradients (55 [25-81] mm Hg vs 58 [25-88] mm Hg; P=.116). Overall operative mortality (≤30 days after surgery) was 1.0% and higher in patients who underwent concomitant CABG (2.2% vs 0.8%; P=.048). In multivariable analysis (n=2641), factors independently associated with mortality included concomitant CABG (hazard ratio [95% CI], 1.89 [1.39-2.58]; P<.0001), older age at operation (per interquartile range increase, 2.79 [1.95-3.98]; P<.0001), atrial fibrillation (1.46 [1.11-1.92]; P=.006), diabetes (1.45 [1.04-2.04]; P=.031), higher body mass index (change from 0.95 to 0.5 quantile, 1.95 [1.46-2.59]; P<.0001), and surgery performed earlier in the study period (2.02 [1.31-3.11]; P=.001). In conclusion, obstructive coronary artery disease severe enough to prompt concomitant CABG at the time of septal myectomy is an important risk factor for late mortality.

肥厚型心肌病患者的严重冠状动脉疾病与死亡风险成比例增加。很少有数据表明在进行子宫切除术时冠状动脉血运重建的长期影响。在1961年1月1日至2017年10月31日期间，Mayo诊所对2913名成年患者进行了主动脉间隔肌切开术。246例（8.4％）同时进行冠状动脉搭桥术（CABG）。我们比较了接受和不接受CABG的间隔肌切除术患者的基线特征，并评估了手术血运重建对全因死亡风险的影响。伴随CABG的患者年龄较大（中位[四分位间距]，分别为66.3 [59.8-72.1]岁和54.4 [43.5-64.8]岁；P<.0001），与未进行冠状动脉血运重建术的男性相比，男性更有可能（63.0％比54.2％；P = .008）。术前左心室流出道梯度无明显差异（55 [25-81] mm Hg vs 58 [25-88] mm Hg；P = .116）。伴有CABG的患者的总手术死亡率（手术后≤30天）为1.0％或更高（2.2％vs. 0.8％；P = .048）。在多变量分析中（n = 2641），与死亡率独立相关的因素包括伴随的CABG（危险比[95％CI]，1.89 [1.39-2.58]；P <.0001），手术年龄（每四分位间距增加，2.79） [1.95-3.98]；P <.0001），房颤（1.46 [1.11-1.92]; P= .006），糖尿病（1.45 [1.04-2.04]；P = .031），较高的体重指数（从0.95分位数改为0.5分位数，1.95 [1.46-2.59]；P <.0001），并且在研究期（2.02 [1.31-3.11]；P = .001）。总之，梗阻性冠状动脉疾病的严重程度足以在间隔肌层切除术时提示同时发生CABG，是晚期死亡的重要危险因素。