In conclusion, there have been significant advances in the risk stratification of HCM since the disease was first described over 5 decades ago. The heterogeneous nature of the disease and the variation in trigger factors provides an adequate explanation for the low predictive accuracy of most conventional risk factors in isolation. A new risk model for risk stratification proposed by the ESC HCM outcome group shows promise but requires validation in different cohorts. The ICD is the only effective therapy in preventing SCD for the disease with a relatively low adverse event rate, but most deaths occur in relatively young patients. However, it is also difficult to ignore the complications with the ICD, therefore, the strife to perfect risk stratification in HCM should continue to ensure that only the most high-risk patients receive an ICD.