The five year outcomes of the multicenter open label COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) were presented at ACC 2023; it included 614 patients with cardiac failure (CF) and moderate to severe (3+/4+) symptomatic secondary mitral regurgitation, despite medical therapy.
Patients were randomized 1:1 to MItraClip + medical therapy (N=302) or medical therapy alone (N=312). 24 month outcomes showed that patients treated with MitraClip had better survival, reduced hospitalization rate for CF and better quality of life vs. medical therapy alone.
We should note that, according to the author, patients randomized to medical therapy alone were not allowed to cross over to the MitraClip before 24 months. Only after this period were they allowed to cross over.
The aim of this study was to describe 5 year outcomes and look at the impact of MitraClip treatment in patients initially randomized to medical therapy alone.
Primary end point was hospitalization for CF, and there was also a safety end point. Mean age was 72, patients were mostly men. More than half presented high surgical risk. Etiology was mostly ischemic and clinical presentation was most often class III of the NYHA followed by class II.
As regard outcomes, hospitalization rate for CF at 5 years was significantly lower in the MitraClip group vs medical therapy alone (HR [95% CI] = 0.51 [0.39, 0.66]).
Read also: Left Main Revascularization: 12 Year Registry in Canada.
Rate of death or hospitalization for CF was also significantly lower: MitraClip group 73.6% vs the medical therapy group 91.5% (HR [95% CI] = 0.53 [0.44-0.64]). Crossover patients showed similar outcomes at followup to the MitraClip patients, showing therefore the benefit of this intervention.
Conclusion
In patients with CF and symptomatic secondary severe mitral regurgitation, treatment with MitraClip plus medical therapy was shown safe, reducing hospitalizations for CF and improving survival at 5 years. This benefit was consistent across subgroups. This is why patients who make good candidates for MItraClip should be identified and assessed to receive treatment as soon as possible.
Dr. Andrés Rodríguez.
Member of the editorial board of SOLACI.org.
Original Title: 5-Year Follow-Up After Transcatheter Repair of Secondary Mitral Regurgitation The COAPT Trial.
Author: G.W. Stone MD.
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