Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial

Gennaro Giustino; Anton Camaj; Samir R. Kapadia; Saibal Kar; William T. Abraham; Jo Ann Lindenfeld; D. Scott Lim; Paul A. Grayburn; David J. Cohen; Björn Redfors; Zhipeng Zhou; Stuart J. Pocock; Federico M. Asch; Michael J. Mack; Gregg W. Stone

doi:10.1016/j.jacc.2022.08.803

Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial

Gennaro Giustino, Anton Camaj, Samir R. Kapadia, Saibal Kar, William T. Abraham, Jo Ann Lindenfeld, D. Scott Lim, Paul A. Grayburn, David J. Cohen, Björn Redfors, Zhipeng Zhou, Stuart J. Pocock, Federico M. Asch, Michael J. Mack, Gregg W. Stone

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

Background: The impact of transcatheter edge-to-edge repair (TEER) on the rate and prognostic impact of hospitalizations in patients with heart failure (HF) and severe secondary mitral regurgitation is unknown. Objectives: This study sought to evaluate the effect of the MitraClip percutaneous edge-to edge repair system on fatal and nonfatal hospitalizations and their relationship with mortality in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. Methods: Patients with HF (n = 614) with severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. Hospitalizations were classified as fatal if death occurred during that hospitalization or nonfatal if the patient was discharged alive. Results: At 2 years, TEER treatment, compared with GDMT alone, resulted in lower time-to-first-event rates of any heart failure hospitalization (HFH) (34.8% vs 56.4%; HR: 0.51; 95% CI: 0.39-0.66) and fatal HFH (6.5% vs 12.6%; HR: 0.47; 95% CI: 0.26-0.85). TEER also resulted in lower rates of all-cause nonfatal and fatal hospitalizations. During the 2-year follow-up period, patients who underwent TEER spent an average of 2 more months alive and out of the hospital than did patients treated with GDMT alone (581 ± 27 days vs 519 ± 26 days; P = 0.002). All HFHs (adjusted HR: 6.37; 95% CI: 4.63-8.78) and nonfatal HFHs (adjusted HR: 1.78; 95% CI: 1.27-2.49) were consistently independently associated with increased 2-year mortality in both the TEER and GDMT groups (P_interaction = 0.34 and 0.39, respectively). Conclusions: In the COAPT trial, compared with GDMT alone, patients with HF and severe secondary mitral regurgitation undergoing TEER with the percutaneous edge-to edge repair system had lower 2-year rates of fatal and nonfatal all-cause hospitalizations and HFH and spent more time alive and out of the hospital. HFHs were strongly associated with mortality, irrespective of treatment.

Original language	English
Pages (from-to)	1857-1868
Number of pages	12
Journal	Journal of the American College of Cardiology
Volume	80
Issue number	20
DOIs	https://doi.org/10.1016/j.jacc.2022.08.803
State	Published - 15 Nov 2022

Keywords

guideline-directed medical therapy
in-hospital mortality
mitral valve insufficiency
transcatheter mitral valve repair

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10.1016/j.jacc.2022.08.803

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Giustino, G., Camaj, A., Kapadia, S. R., Kar, S., Abraham, W. T., Lindenfeld, J. A., Lim, D. S., Grayburn, P. A., Cohen, D. J., Redfors, B., Zhou, Z., Pocock, S. J., Asch, F. M., Mack, M. J., & Stone, G. W. (2022). Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial. Journal of the American College of Cardiology, 80(20), 1857-1868. https://doi.org/10.1016/j.jacc.2022.08.803

@article{cd99cb37dd754fe48368d8f201761367,

title = "Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial",

abstract = "Background: The impact of transcatheter edge-to-edge repair (TEER) on the rate and prognostic impact of hospitalizations in patients with heart failure (HF) and severe secondary mitral regurgitation is unknown. Objectives: This study sought to evaluate the effect of the MitraClip percutaneous edge-to edge repair system on fatal and nonfatal hospitalizations and their relationship with mortality in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. Methods: Patients with HF (n = 614) with severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. Hospitalizations were classified as fatal if death occurred during that hospitalization or nonfatal if the patient was discharged alive. Results: At 2 years, TEER treatment, compared with GDMT alone, resulted in lower time-to-first-event rates of any heart failure hospitalization (HFH) (34.8% vs 56.4%; HR: 0.51; 95% CI: 0.39-0.66) and fatal HFH (6.5% vs 12.6%; HR: 0.47; 95% CI: 0.26-0.85). TEER also resulted in lower rates of all-cause nonfatal and fatal hospitalizations. During the 2-year follow-up period, patients who underwent TEER spent an average of 2 more months alive and out of the hospital than did patients treated with GDMT alone (581 ± 27 days vs 519 ± 26 days; P = 0.002). All HFHs (adjusted HR: 6.37; 95% CI: 4.63-8.78) and nonfatal HFHs (adjusted HR: 1.78; 95% CI: 1.27-2.49) were consistently independently associated with increased 2-year mortality in both the TEER and GDMT groups (Pinteraction = 0.34 and 0.39, respectively). Conclusions: In the COAPT trial, compared with GDMT alone, patients with HF and severe secondary mitral regurgitation undergoing TEER with the percutaneous edge-to edge repair system had lower 2-year rates of fatal and nonfatal all-cause hospitalizations and HFH and spent more time alive and out of the hospital. HFHs were strongly associated with mortality, irrespective of treatment.",

keywords = "guideline-directed medical therapy, in-hospital mortality, mitral valve insufficiency, transcatheter mitral valve repair",

author = "Gennaro Giustino and Anton Camaj and Kapadia, {Samir R.} and Saibal Kar and Abraham, {William T.} and Lindenfeld, {Jo Ann} and Lim, {D. Scott} and Grayburn, {Paul A.} and Cohen, {David J.} and Bj{\"o}rn Redfors and Zhipeng Zhou and Pocock, {Stuart J.} and Asch, {Federico M.} and Mack, {Michael J.} and Stone, {Gregg W.}",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Cardiology Foundation",

year = "2022",

month = nov,

day = "15",

doi = "10.1016/j.jacc.2022.08.803",

language = "English",

volume = "80",

pages = "1857--1868",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "20",

}

Giustino, G, Camaj, A, Kapadia, SR, Kar, S, Abraham, WT, Lindenfeld, JA, Lim, DS, Grayburn, PA, Cohen, DJ, Redfors, B, Zhou, Z, Pocock, SJ, Asch, FM, Mack, MJ & Stone, GW 2022, 'Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial', Journal of the American College of Cardiology, vol. 80, no. 20, pp. 1857-1868. https://doi.org/10.1016/j.jacc.2022.08.803

TY - JOUR

T1 - Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure

T2 - The COAPT Trial

AU - Giustino, Gennaro

AU - Camaj, Anton

AU - Kapadia, Samir R.

AU - Kar, Saibal

AU - Abraham, William T.

AU - Lindenfeld, Jo Ann

AU - Lim, D. Scott

AU - Grayburn, Paul A.

AU - Cohen, David J.

AU - Redfors, Björn

AU - Zhou, Zhipeng

AU - Pocock, Stuart J.

AU - Asch, Federico M.

AU - Mack, Michael J.

AU - Stone, Gregg W.

PY - 2022/11/15

Y1 - 2022/11/15

N2 - Background: The impact of transcatheter edge-to-edge repair (TEER) on the rate and prognostic impact of hospitalizations in patients with heart failure (HF) and severe secondary mitral regurgitation is unknown. Objectives: This study sought to evaluate the effect of the MitraClip percutaneous edge-to edge repair system on fatal and nonfatal hospitalizations and their relationship with mortality in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. Methods: Patients with HF (n = 614) with severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. Hospitalizations were classified as fatal if death occurred during that hospitalization or nonfatal if the patient was discharged alive. Results: At 2 years, TEER treatment, compared with GDMT alone, resulted in lower time-to-first-event rates of any heart failure hospitalization (HFH) (34.8% vs 56.4%; HR: 0.51; 95% CI: 0.39-0.66) and fatal HFH (6.5% vs 12.6%; HR: 0.47; 95% CI: 0.26-0.85). TEER also resulted in lower rates of all-cause nonfatal and fatal hospitalizations. During the 2-year follow-up period, patients who underwent TEER spent an average of 2 more months alive and out of the hospital than did patients treated with GDMT alone (581 ± 27 days vs 519 ± 26 days; P = 0.002). All HFHs (adjusted HR: 6.37; 95% CI: 4.63-8.78) and nonfatal HFHs (adjusted HR: 1.78; 95% CI: 1.27-2.49) were consistently independently associated with increased 2-year mortality in both the TEER and GDMT groups (Pinteraction = 0.34 and 0.39, respectively). Conclusions: In the COAPT trial, compared with GDMT alone, patients with HF and severe secondary mitral regurgitation undergoing TEER with the percutaneous edge-to edge repair system had lower 2-year rates of fatal and nonfatal all-cause hospitalizations and HFH and spent more time alive and out of the hospital. HFHs were strongly associated with mortality, irrespective of treatment.

AB - Background: The impact of transcatheter edge-to-edge repair (TEER) on the rate and prognostic impact of hospitalizations in patients with heart failure (HF) and severe secondary mitral regurgitation is unknown. Objectives: This study sought to evaluate the effect of the MitraClip percutaneous edge-to edge repair system on fatal and nonfatal hospitalizations and their relationship with mortality in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. Methods: Patients with HF (n = 614) with severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) versus GDMT alone. Hospitalizations were classified as fatal if death occurred during that hospitalization or nonfatal if the patient was discharged alive. Results: At 2 years, TEER treatment, compared with GDMT alone, resulted in lower time-to-first-event rates of any heart failure hospitalization (HFH) (34.8% vs 56.4%; HR: 0.51; 95% CI: 0.39-0.66) and fatal HFH (6.5% vs 12.6%; HR: 0.47; 95% CI: 0.26-0.85). TEER also resulted in lower rates of all-cause nonfatal and fatal hospitalizations. During the 2-year follow-up period, patients who underwent TEER spent an average of 2 more months alive and out of the hospital than did patients treated with GDMT alone (581 ± 27 days vs 519 ± 26 days; P = 0.002). All HFHs (adjusted HR: 6.37; 95% CI: 4.63-8.78) and nonfatal HFHs (adjusted HR: 1.78; 95% CI: 1.27-2.49) were consistently independently associated with increased 2-year mortality in both the TEER and GDMT groups (Pinteraction = 0.34 and 0.39, respectively). Conclusions: In the COAPT trial, compared with GDMT alone, patients with HF and severe secondary mitral regurgitation undergoing TEER with the percutaneous edge-to edge repair system had lower 2-year rates of fatal and nonfatal all-cause hospitalizations and HFH and spent more time alive and out of the hospital. HFHs were strongly associated with mortality, irrespective of treatment.

KW - guideline-directed medical therapy

KW - in-hospital mortality

KW - mitral valve insufficiency

KW - transcatheter mitral valve repair

UR - http://www.scopus.com/inward/record.url?scp=85140999719&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2022.08.803

DO - 10.1016/j.jacc.2022.08.803

M3 - Article

AN - SCOPUS:85140999719

SN - 0735-1097

VL - 80

SP - 1857

EP - 1868

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 20

ER -

Hospitalizations and Mortality in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial

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Keywords

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