This new analysis shows the mechanism behind the benefit of using MitraClip and the necessary degree of residual mitral regurgitation (MR) to have an impact.
Regardless the intervention type, patients with cardiac failure and secondary mitral regurgitation present lower hospitalization for cardiac failure, all-cause mortality and improved quality of life the lower the MR.
MitraClip superiority to achieve and maintain MR reduction seems to be the mechanism behind the observed benefit in COAPT.
Whenever achieving 2+ MR is possible is when we start seeing results, and when comparing patients with 2+ residual MR vs. patients with 1+ residual MR there are no important differences in benefit.
The 614 COAPT patients presented 3+ or 4+ MR at the start of the study. At 30 days, 73% of patients receiving MitraClip had 0/1+, close to 20% had 2+ and 7.4% had 3+ MR or more.
On the contrary, only 34.3% of patients treated strictly according to guidelines reached a 2+ reduction or more in the same period.
But while the MitraClip was superior than the best medical treatment at reducing MR, according to this study, it remains unclear why reduction with medical treatment has the same durability and prognostic impact.
Primary end point rate (time to first hospitalization for cardiac failure or all-cause death) was significantly higher for patients with residual MR 3+ or higher (73.5%) vs. those reaching 0/1+ (38.6%) or 2+ (49.8% p<0.001 for all comparisons) with no significant differences between the group 0/1+ vs 2+.
As regards quality of life scores at 12 months, patients with residual MR 0/1+ or 2+ scored nearly twice as high as baseline values vs. patients with 3+ residual MR.
Original Title: Relationship between residual mitral regurgitation and clinical and functional outcomes in the COAPT trial.
Presenter: Kar S.
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