Improvements in COAPT Trial for Functional Mitral Regurgitation

Patients with heart failure and moderate-to-severe secondary mitral regurgitation may benefit from transcatheter mitral valve repair. There are benefits at 3 years, even in hard points such as mortality rate.

COAPT insuficiencia mitral funcional

The COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial showed fewer heart failure hospitalizations and lower mortality at 24 months.

The original results published by EuroPCR 2019 can be found in the following link. This study randomized 614 patients with heart failure and moderate-to-severe secondary mitral regurgitation, who had remained symptomatic despite receiving optimal medical treatment, to MitraClip plus optimal medical treatment vs. optimal medical treatment alone.

The novelty with this trial is the increased follow-up, maintaining the original benefit.


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The annualized rates of heart failure hospitalization were 35.5% in the group that received MitraClip, compared with 68.8% in the group that only received optimal medical treatment (hazard ratio [HR]: 0.49; 95% confidence interval [CI]: 0.37 to 0.63; p < 0.001). The number of patients needed to treat with MitraClip to get this benefit is 3.

Mortality was 42.8% in the MitraClip group versus 55.5% in the control group (HR: 0.67; 95% CI: 0.52 to 0.85; p = 0.001). The number of patients needed to treat to get this benefit in terms of mortality rate is 8.

Patients treated with MitraClip had sustained improvement in mitral regurgitation severity, quality-of-life measures, and functional capacity.


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There were 58 patients assigned to optimal medical treatment alone who crossed over and were treated with MitraClip. They derived a benefit in terms of both mortality and heart failure hospitalization, compared with those who continued receiving optimal medical treatment alone.

Conclusion

Patients with heart failure and moderate-to-severe secondary mitral regurgitation, who remain symptomatic despite optimal medical treatment, benefited from transcatheter mitral valve repair (TMVr) using MitraClip. This benefit is durable, reduces heart failure hospitalization, and improves quality-of-life measures and functional capacity at 3 years of follow-up.

Patients who crossed over from only optimal medical treatment to MitraClip had a prognosis comparable to those originally assigned to MitraClip.

Los pacientes que se cruzaron de rama (TMO a MitraClip) mostraron un pronóstico similar al de los pacientes que fueron asignados originalmente a MitraClip.

Original Title: 3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure.

Reference: Michael J Mack et al. J Am Coll Cardiol. 2021 Mar 2;77(8):1029-1040. doi: 10.1016/j.jacc.2020.12.047.


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