Negative one-year outcomes of Mitra-FR led to several discussions and hypothesis, especially after the COAPT was published only a few weeks later. According to the COAPT study, the MitraClip was able to reduce hospitalization rate for cardiac failure and also all-cause mortality, compared against optimal medical treatment alone. When comparing the COAPT to the Mitra-FR, contrasting outcomes were explained by the shorter follow-up of the latter, and therefore better outcomes were expected from a longer follow-up period.
Unfortunately, Mitra-FR 2-year outcomes, presented on Monday, have confirmed those first results. The composite of all cause death and unplanned hospitalization for cardiac failure was similar between the groups (64.2% for the MitraClip vs 68.6% for the group receiving optimal medical treatment alone).
All-cause mortality was 34.9% for the MitraClip and 34.2% for the control group (HR 1.02; CI 95% 0.70 to 1.50), and unplanned hospitalization rate for cardiac failure was 55.9% for MitraClip and 61.8% for the control group (HR 0.97; CI 95% 0.72 to 1.30). There was a trend in favor of the intervention group that did not reach statistical significance.
These results confirm the initial results of Mitra-FR and perhaps we should think the difference with the COAPT outcomes lies on population characteristics rather than follow-up period.
It seems obvious that we need further research on percutaneous repair of secondary mitral regurgitation to be able to better identify what patients will really benefit.
Original title: 2-year follow-up of the MITRA-FR study: effectiveness of percutaneous mitral valve repair in secondary mitral regurgitation.
Reference: Presentado por Jean-François Obadia en el ESC 2019. Paris, Francia.
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