Severe secondary mitral valve regurgitation is associated to hospitalization and mortality.
The COAPT study has shown the superiority of guideline directed medical therapy at maximal tolerated doses according to guidelines (GDMT) plus edge-to-edge transcatheter repair (TEER) versus GMDT alone.
However, at present there is no information on the impact of hospitalizations and their relationship to all-cause or cardiovascular mortality.
The COAPT study was analyzed, including 614 patients: 302 receiving GDMT + TEER and 312 GDMT alone.
This analysis included hospitalization for any cause (ACH), hospitalization for cardiovascular cause (CCH), hospitalization for cardiac failure (CFH), non-cardiovascular related hospitalization (NCCH), and all-cause mortality.
436 patients (71%) had been hospitalized at least once at 2-year followup.
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Mean age was 74, 35% were women. There were no differences in diabetes, hypertension, COPD, PCI, CABG, and peripheral vascular disease. Hospitalized patients showed higher rates of kidney failure, atrial fibrillation, STS score, and higher BNP, in addition to worse 6-minute walk test performance and worse quality of life. The echo-Doppler prior randomization showed more severe tricuspid failure and higher right ventricular systolic pressure.
There was no difference between patients receiving GMDT + TEER o GMDT alone between randomization and first hospitalization. Mean time was 253 days.
After 2 years, patients receiving GDMT + TEER presented lower ACH, CCH and CFH globally, both fatal and non-fatal, with no difference in NCCH or hospitalization not related to cardiac failure.
In addition, those receiving the device lived 2 months longer and outside the hospital.
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Mortality was associated to hospitalization, growing significantly as the number of hospitalizations increased.
At multivariable analysis, GMDT + TEER was associated with significantly lower all-cause and cardiovascular mortality and hospitalization for cardiac failure.
Conclusion
The COAPT looked at patients with heart failure and severe secondary mitral valve regurgitation receiving GDMT + TEER, presenting at 2 years fewer fatal hospitalizations, fewer hospitalizations for cardiac failure, and longer survival outside the hospital vs. patients receiving GDMT alone. Hospitalization for cardiac failure was strongly associated with mortality, regardless the treatment.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure The COAPT Trial.
Reference: Gennaro Giustino, et al. J Am Coll Cardiol 2022;80:1857–1868.
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