Risk reduction of long-term major adverse cardiovascular events after endoscopic thoracic sympathectomy in palmar hyperhidrosis

Purpose: Palmar hyperhidrosis (PH) is excessive sweating of the palms resulting from sympathetic overactivity, and patients who undergo endoscopic thoracic sympathectomy (ETS) show reduced cardiac demand after 1 year and improved cerebral perfusion within 2–4 weeks. However, the long-term risks of major adverse cardiovascular events (MACE) following ETS remain unclear. Methods: We searched the Longitudinal National Health Insurance Database in Taiwan and identified PH patients (International Classification of Disease, Ninth Revision, Clinical Modification diagnostic code 708.8) from the outpatient database and patients who underwent ETS (procedure code 05.29) from the inpatient database between 2000 and 2010; furthermore, we excluded patients younger than 18 years of age or older than 65 years of age. We defined MACE as stroke (diagnostic codes 430–437), myocardial infarction (diagnostic code 410), or death. Patients followed until the first cardiac event or December 31, 2010. Risk factors were identified using a multivariable Cox proportional hazards regression. Results: The incidence of MACE was significantly lower in patients with ETS (0.76%) than without (1.67%). In PH patients, ETS significantly reduced the risk of MACE (adjusted hazard ratio 0.473; 95% confidence interval 0.277–0.808). Conclusion: PH patients who underwent ETS showed a reduced risk of MACE over a long-term follow-up period. This result could provide support for patients with PH who are considering undergoing ETS because of its additional cardiovascular benefits.