COAPT-Like Profile Predicts MitraClip Implantation Outcomes

Quick Takes

  • Having a COAPT-like profile was associated with similar procedural results but better clinical outcomes compared with not having a COAPT-like profile.
  • Furthermore, among COAPT exclusion criteria, RV impairment, pulmonary hypertension, and hemodynamic instability were associated with poorer outcomes at short-term follow-up, whereas LV impairment identified patients with poorer outcomes in the longer-term.
  • Additional studies are needed to better define the role of COAPT exclusion criteria in predicting outcome after MitraClip implantation and the possible beneficial effect of optimal medical therapy.

Study Questions:

Does fulfilling COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) criteria identify patients with better outcomes after MitraClip treatment for secondary mitral regurgitation (SMR)?

Methods:

The investigators analyzed 304 patients with SMR undergoing MitraClip placement in addition to optimal medical therapy at three European centers. A COAPT-like profile was defined as absence of all of the following criteria: severe left ventricular (LV) impairment, moderate to severe right ventricular (RV) dysfunction, severe tricuspid regurgitation, severe pulmonary hypertension, and hemodynamic instability. Freedom from all-cause death and from a composite endpoint (cardiovascular death and heart failure hospitalization) were evaluated at 2- and 5-year follow-up. Survival rate free from clinical endpoints was estimated using the Kaplan-Meier method, and the differences between groups were calculated using the log-rank test.

Results:

A COAPT-like profile was observed in 65% of the population. Compared with non-COAPT-like patients, those fulfilling COAPT criteria had greater survival free from all-cause death and from the composite endpoint at both 2-year (75% vs. 55% and 67% vs. 47%; p < 0.001 for both) and 5-year (49% vs. 25% and 40% vs. 19%; p < 0.001 for both) follow-up. Among the non-COAPT-like patients, similar outcomes were observed in those fulfilling 1 or ≥1 criterion. LV impairment had a late impact on outcomes, while right ventricular impairment, pulmonary hypertension, and hemodynamic instability had early effects. COAPT-like profile was an independent predictor of long-term outcomes, as well as administration of neurohormonal antagonists, European System for Cardiac Operative Risk Evaluation II score, and previous heart failure hospitalization.

Conclusions:

The authors concluded that a COAPT-like profile, including specific echocardiographic and clinical criteria, identifies patients with SMR who have a better prognosis after MitraClip implantation.

Perspective:

This study reports that almost two-thirds of patients with SMR undergoing MitraClip implantation had a COAPT-like profile and having a COAPT-like profile was associated with similar procedural results but better clinical outcomes compared with not having a COAPT-like profile. Furthermore, among COAPT exclusion criteria, RV impairment, pulmonary hypertension, and hemodynamic instability were associated with poorer outcomes at short-term follow-up, whereas LV impairment identified patients with poorer outcomes in the longer-term. Additional studies are indicated to better define the role of COAPT exclusion criteria in predicting outcome after MitraClip implantation and the possible complementary effect of optimal medical therapy.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Pulmonary Hypertension, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Mitral Regurgitation

Keywords: Cardiac Surgical Procedures, Echocardiography, Heart Failure, Heart Valve Diseases, Hemodynamics, Hypertension, Pulmonary, Mitral Valve Insufficiency, Outcome Assessment (Health Care), Primary Prevention, Tricuspid Valve Insufficiency, Ventricular Dysfunction, Left, Ventricular Dysfunction, Right


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