AI Article Synopsis
- - The study focused on Mitral valve transcatheter edge-to-edge repair (MTEER) for functional mitral regurgitation (FMR), evaluating patients not included in the COAPT trial, analyzing outcomes through the Transcatheter Valve Therapy Registry data from 2013 to 2020.
- - Out of 6,675 patients, 55.7% were eligible and 44.3% were ineligible for the trial, with ineligible patients experiencing lower procedural success and more in-hospital complications but similar health status improvements at 30 days post-procedure.
- - However, trial-ineligible patients had a significantly higher risk of death or hospitalization due to heart failure within a year, highlighting differences in
Article Abstract
Background: Mitral valve transcatheter edge-to-edge repair (MTEER) was approved in the United States for treatment of functional mitral regurgitation (FMR) based on results from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial.
Objectives: The authors sought to analyze outcomes of MTEER in FMR patients who would have been excluded from COAPT.
Methods: MTEER procedures performed for FMR in the TVT (Transcatheter Valve Therapy) Registry between January 1, 2013, and April 30, 2020, were categorized as "trial-ineligible" if any of the following were present: cardiogenic shock, inotropic support, left ventricular ejection fraction <20%, left ventricular end-systolic dimension >7 cm, home oxygen use, or severe tricuspid regurgitation. Trial-ineligible and trial-eligible groups were compared through 1 year using multivariable models. The primary endpoint was 1-year death or heart failure hospitalization (HFH).
Results: Of 6,675 patients who underwent MTEER for FMR, 3,721 (55.7%) were trial-eligible and 2,954 (44.3%) were trial-ineligible. Trial-ineligible patients had lower rates of technical procedural success (86.9% vs 92.6%; P < 0.001) and more frequent in-hospital complications (11.8% vs 5.7%; P < 0.001) compared with trial-eligible patients. A clinically meaningful improvement in health status at 30 days was observed in 78.9% and 77.0% of patients in the trial-ineligible and trial-eligible groups, respectively. There was a higher risk of 1-year death or HFH (HR: 1.73; 95% CI: 1.57-1.91; P < 0.001) in trial-ineligible patients.
Conclusions: Among patients who underwent MTEER for FMR in the TVT Registry, nearly one-half would have been ineligible for the COAPT trial. Health status improvement at 30 days was similar in COAPT-ineligible and COAPT-eligible patients, but trial-ineligible patients had higher 1-year rates of death or HFH.
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| http://dx.doi.org/10.1016/j.jacc.2023.11.012 | DOI Listing |
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