A meta analysis of current status of alcohol septal ablation and surgical myectomy for obstructive hypertrophic cardiomyopathy
Bibliographic record
Abstract
OBJECTIVE: Our objective was to perform an updated systematic review to compare the efficacy and short- and long-term mortality of surgical myectomy (SM) and alcohol septal ablation (ASA) by including most recent and largest cohort studies published in last few years. BACKGROUND: SM and ASA are the two invasive strategies used to relieve left ventricular outflow tract obstruction (LVOTO) in patients with drug refractory symptomatic hypertrophic cardiomyopathy (HCM). In the absence of a randomized trial, we tried to compare the pros and cons of the two procedures using a systematic review and meta-analysis. METHOD: A comprehensive search of three major databases was performed. We included original research studies comparing data on ASA and SM. Of 1,143 citations, 10 studies were included in the analysis. RESULTS: A total of 805 patients underwent ASA and 1,019 underwent SM. Patients undergoing SM were younger (MD 6.3, P = 0.0001) and had higher reduction in the LVOT gradient (MD -9.56, P = 0.05). However, there was similar resolution of class III and IV symptoms between the two groups (P = 0.56). There was no difference in sudden cardiac death (SCD) (P = 0.93), short-term (P = 0.36), long-term all cause (P = 0.27), and long-term cardiac mortality (P = 0.58). Patients undergoing ASA had higher incidence of post procedure device implantation (OR 3.09, P < 0.00001). CONCLUSION: No significant difference in symptom relief was noted between the two approaches. ASA was as safe a myectomy with regards to SCD, short-term, and long-term mortality. © 2015 Wiley Periodicals, Inc.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.029 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.032 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".