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COAPT-Like Profile Predicts Long-Term Outcomes in Patients With Secondary Mitral Regurgitation Undergoing MitraClip

Marianna Adamo1, Francesca Fiorelli2, Bruno Melica3

  • 1Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy.

JACC. Cardiovascular Interventions
|December 14, 2020
PubMed

Insights

Patients meeting Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) criteria show improved survival after MitraClip treatment for secondary mitral regurgitation (SMR). This profile identifies SMR patients with better long-term prognosis.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Heart Failure Management

Background:

  • The COAPT trial demonstrated prognostic benefit of MitraClip implantation over conservative management for functional secondary mitral regurgitation (SMR).
  • Identifying patients most likely to benefit from MitraClip is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To evaluate if adherence to COAPT criteria predicts better outcomes in patients undergoing MitraClip for SMR.
  • To assess the prognostic value of a "COAPT-like" profile in a real-world European cohort.

Main Methods:

  • Retrospective analysis of 304 patients with SMR treated with MitraClip and optimal medical therapy across 3 European centers.
  • Definition of a "COAPT-like" profile based on the absence of severe left ventricular impairment, moderate-to-severe right ventricular dysfunction, severe tricuspid regurgitation, severe pulmonary hypertension, and hemodynamic instability.
  • Evaluation of freedom from all-cause death and a composite endpoint (cardiovascular death, heart failure hospitalization) at 2- and 5-year follow-up.

Main Results:

  • A COAPT-like profile was present in 65% of analyzed patients.
  • Patients with a COAPT-like profile exhibited significantly greater 2- and 5-year survival free from all-cause death and the composite endpoint compared to non-COAPT-like patients (p < 0.001 for both).
  • Left ventricular impairment had a late impact, while right ventricular issues, pulmonary hypertension, and hemodynamic instability had early effects on outcomes. The COAPT-like profile independently predicted long-term outcomes.

Conclusions:

  • A "COAPT-like" profile, defined by specific clinical and echocardiographic criteria, effectively identifies patients with SMR who experience superior prognosis following MitraClip implantation.
  • This finding supports the use of COAPT criteria in patient selection for MitraClip therapy in SMR.
Abstract

Keywords:
COAPT-like profileMitraClipoutcomespatient selection

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