Adapted COAPT criteria tied to lower death rates in patients undergoing mitral edge-to-edge repair

A recent study has successfully identified a specific phenotype demonstrating reduced mortality rates in patients with secondary mitral regurgitation undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) by retrospectively applying the adapted COAPT* enrolment criteria.

In contrast, stratification according to adapted MITRA-FR** criteria has resulted in comparable outcomes.

In this study, the authors retrospectively applied the adapted enrolment criteria approaching those used in the COAPT and MITRA-FR trials to a European real-world registry to examine the effect of these criteria on outcomes.

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

Stratification of patients according to adapted MITRA-FR criteria resulted in comparable all-cause mortality (p=0.19), but the application of adapted COAPT enrolment criteria led to lower mortality rates in eligible compared with ineligible patients (p<0.001).

In multivariable Cox regression analysis, the following factors independently predicted outcomes: New York Heart Association functional class IV (hazard ratio [HR], 2.29, 95 percent confidence interval [CI], 1.53–3.42; p<0.001), logarithmic N-terminal pro–brain natriuretic peptide (HR, 1.47, 95 percent CI, 1.24–1.75; p<0.001), and right ventricular–to–pulmonary arterial coupling (HR, 0.10, 95 percent CI, 0.02–0.57; p=0.009).

Interestingly, functional outcome improved in a subset of patients regardless of COAPT eligibility status.

*Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation

**Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation