Surgical myectomy (SM), performed to relieve dynamic left ventricular outflow tract obstruction (LVOTO) in symptomatic obstructive hypertrophic cardiomyopathy (oHCM) patients provides improved quality of life and symptoms and excellent long-term survival. Guidelines recommend SM in symptomatic oHCM patients refractory to optimal medical therapy. We sought to assess whether SM in patients with fewer symptoms at initial referral is associated with improved long-term outcomes in oHCM. Baseline symptom burden at the time of referral emerged as a powerful prognostic discriminator among 3,546 HCM patients undergoing SM. Our findings suggest that earlier surgical referral before advanced decompensation may be associated with more favorable long-term outcomes. Women were more likely to present with advanced symptoms and had higher adjusted risk. These results underscore the need to determine whether a proactive therapeutic strategy, including an earlier intervention, can modify long-term survival in oHCM.