Outcomes Stratified by Adapted Inclusion Criteria After Mitral Edge-to-Edge Repair.

Koell, Benedikt; Orban, Mathias; Weimann, Jessica; Kassar, Mohammad; Karam, Nicole; Neuss, Michael; Petrescu, Aniela; Iliadis, Christos; Unterhuber, Matthias; Adamo, Marianna; Giannini, Cristina; Melica, Bruno; Ludwig, Sebastian; Massberg, Steffen; Praz, Fabien; Pfister, Roman; Thiele, Holger; Stephan von Bardeleben, Ralph; Baldus, Stephan; Butter, Christian; ... (2021). Outcomes Stratified by Adapted Inclusion Criteria After Mitral Edge-to-Edge Repair. Journal of the American College of Cardiology, 78(24), pp. 2408-2421. Elsevier 10.1016/j.jacc.2021.10.011

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BACKGROUND

Although mitral valve transcatheter edge-to-edge repair (M-TEER) achieves symptomatic benefit for a broad spectrum of patients with relevant secondary mitral regurgitation, conflicting data exist on its prognostic impact.

OBJECTIVES

Adapted enrollment criteria approaching those used in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) and MITRA-FR (Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation) trials were retrospectively applied to a European real-world registry to evaluate the influence of the respective criteria on outcomes.

METHODS

A total of 1,022 patients included in the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry and treated with M-TEER (November 2008 to September 2019) were stratified into COAPT-eligible (n = 353 [34.5%]) and COAPT-ineligible (n = 669 [65.5%]) as well as MITRA-FR-eligible (n = 408 [48.3%]) and MITRA-FR-ineligible (n = 437 [51.7%]) groups.

RESULTS

Although the stratification of patients according to adapted MITRA-FR criteria led to comparable outcomes regarding all-cause mortality (P = 0.19), the application of adapted COAPT enrollment criteria demonstrated lower mortality rates in COAPT-eligible compared with COAPT-ineligible patients (P < 0.001). Multivariable Cox regression analysis identified New York Heart Association functional class IV (hazard ratio [HR]: 2.29; 95% confidence interval [CI]: 1.53-3.42; P < 0.001), logarithmic N-terminal pro-brain natriuretic peptide (HR: 1.47; 95% CI: 1.24-1.75; P < 0.001), and right ventricular-to-pulmonary arterial coupling (HR: 0.10; 95% CI: 0.02-0.57; P = 0.009) as independent predictors of outcome. Yet improvement of functional outcome was demonstrated in a subset of patients irrespective of COAPT eligibility status.

CONCLUSIONS

In this real-world cohort of patients with secondary mitral regurgitation undergoing M-TEER, the retrospective application of adapted COAPT enrollment criteria successfully identified a specific phenotype demonstrating lower mortality rates. On the contrary, stratification according to adapted MITRA-FR criteria resulted in comparable outcomes.

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