COAPT: Transcatheter Mitral Valve Repair Reduced Hospitalizations, Death in Heart Failure

Gregg W. Stone, MD

In patients with heart failure and severe secondary mitral regurgitation, mitral transcatheter edge-to-edge repair (TEER) was associated with lower rates of all hospitalizations, hospitalizations for cardiovascular causes, and hospitalizations for heart failure through 5-years of the COAPT trial.¹

The data, presented at the American College of Cardiology (ACC) 2023 Annual Scientific Sessions in New Orleans, Louisiana, suggest the minimally invasive mitral valve repair procedure cut the rate of hospitalizations for heart failure by 47% and reduced deaths from any cause by approximately 30%.

“These final results show that in a very sick population with mitral valve dysfunction secondary to heart failure, transcatheter mitral valve repair was extremely safe and significantly reduced both hospitalizations due to heart failure and deaths from heart failure or all causes,” said Gregg W. Stone, MD, Director of Academic Affairs, Mount Sinai Health System and lead author of the study in a press release.²

The COAPT trial was designed to determine whether patients with secondary mitral regurgitation would benefit from TEER using the MitraClip from Abbott. At 2-years, TEER was safe and improved outcomes in approximately 600 patients with heart failure and secondary mitral regurgitation who had remained symptomatic despite the use of maximal doses of guideline-directed medical therapy (GDMT).

The 2-year data showed a 47% reduced risk of hospitalization for heart failure among patients who received the MitraClip, compared with the control group. About 97% of TEER patients had no complications with the first year and within two years, 29% of TEER patients died, compared with 46% of patients in the control group. Due to uncertainties regarding the sustainability of the benefit over the long-term, a 5-year follow-up in the COAPT trial was performed.

In the current 5-year analysis, death or hospitalization for heart failure occurred in 73.6% of patients undergoing TEER compared with 91.5% of patients in the control group, a 47% reduction. Data showed the reduced risk of death from any cause for TEER patients compared with controls was 28%. According to the findings, the relative benefit of TEER declined after 3 years, mainly due to patients in the control group allowed to cross-over to undergo TEER.

Despite the favorable risk-benefit profile or mitral TEER, adverse outcomes continued in both groups, as 73.6% of the patients in the device group and 91.5% of patients in the control group either died or were hospitalized for heart failure within 5 years. The research suggests the need to develop better therapies for advanced heart failure to further improve the prognosis of these high-risk patients.

To better elucidate the 5-year COAPT data, HCPLive spoke with Stone on the floor in New Orleans. Watch the video of that interview here:

References

1. Stone GW, Abraham WT, Lindenfeld J, et al. Five-Year Follow-up after Transcatheter Repair of Secondary Mitral Regurgitation [published online ahead of print, 2023 Mar 5]. N Engl J Med. 2023;10.1056/NEJMoa2300213. doi:10.1056/NEJMoa2300213

2. Minimally invasive mitral valve repair reduces hospitalizations and deaths. American College of Cardiology. https://www.acc.org/About-ACC/Press-Releases/2023/03/05/13/58/Minimally-Invasive-Mitral-Valve-Repair. Published March 5, 2023. Accessed March 9, 2023.