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 ORCID: 0000-0001-5416-165X, Pfister, Roman, Thiele, Holger, von Bardeleben, Ralph Stephan ORCID: 0000-0002-1356-0037, Baldus, Stephan, Butter, Christian, Lurz, Philipp, Windecker, Stephan, Metra, Marco, Petronio, Anna Sonia, Hausleiter, Joerg, Lubos, Edith and Kalbacher, Daniel (2021). Outcomes Stratified by Adapted Inclusion Criteria After Mitral Edge-to-Edge Repair. J. Am. Coll. Cardiol., 78 (24). S. 2408 - 2422. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1558-3597

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Abstract

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 MitraCtip 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 (Ca: 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% 0: 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. (C) 2021 by the American College of Cardiology Foundation.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Koell, BenediktUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Orban, MathiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weimann, JessicaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kassar, MohammadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karam, NicoleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neuss, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petrescu, AnielaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Iliadis, ChristosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Unterhuber, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Adamo, MariannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Giannini, CristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Melica, BrunoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ludwig, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Massberg, SteffenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Praz, FabienUNSPECIFIEDorcid.org/0000-0001-5416-165XUNSPECIFIED
Pfister, RomanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thiele, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Bardeleben, Ralph StephanUNSPECIFIEDorcid.org/0000-0002-1356-0037UNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Butter, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lurz, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Windecker, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Metra, MarcoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petronio, Anna SoniaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hausleiter, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lubos, EdithUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kalbacher, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-603237
DOI: 10.1016/j.jacc.2021.10.011
Journal or Publication Title: J. Am. Coll. Cardiol.
Volume: 78
Number: 24
Page Range: S. 2408 - 2422
Date: 2021
Publisher: ELSEVIER SCIENCE INC
Place of Publication: NEW YORK
ISSN: 1558-3597
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
VALVE REPAIR; REGURGITATION; FR; THERAPY; IMPACTMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60323

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