Name:
COAPT Trial
Description:
COAPT Trial
Thumbnail URL:
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Duration:
T00H05M19S
Embed URL:
https://stream.cadmore.media/player/9a7944a1-ebf6-4b63-8ae1-511a851de00b
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/9a7944a1-ebf6-4b63-8ae1-511a851de00b/18777613.mp3?sv=2019-02-02&sr=c&sig=s4zhve10Cr5%2BxhQdV6HlU4pSDngpReTrqvMhQxPj1ZQ%3D&st=2024-12-21T13%3A47%3A33Z&se=2024-12-21T15%3A52%3A33Z&sp=r
Upload Date:
2022-02-28T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's the Heart Board Review and other online resources available only through accesscardiology.com. >> So, is there anything new in the treatment of functional mitral valve regurgitation and congestive heart failure? Certainly, we've been looking for some new interventional medical treatment in this really high-risk group for mortality. >> Hi, Dr. Bernie here, and welcome to Practice Impact Extra.
Severe functional mitral valve regurgitation with congestive heart failure is associated with a very poor clinical prognosis, particularly in those patients considered inoperable. The question is whether transcatheter mitral valve clip can improve clinical outcomes in mortality, reduce hospitalization for CHF, and improve the quality of life. The COAPT trial was published in -- in April 2020 and assessed the safety and cardiovascular outcomes of percutaneous mitral valve clip for heart failure with patients with functional mitral regurgitation.
This trial enrolled 614 patients and randomized those. They had 3 to 4 plus mitral regurgitation and congestive heart failure and remained symptomatic despite maximum medical tolerated, guideline-directed medical therapy. The duration of the trial was 2 years or 24 months. I think this is very important. There was specific inclusion criteria, and it's very important to note these. Ischemic and non-ischemic cardiomyopathy with a left ventricular function of 20% to 50% and a left ventricular end-systolic dimension which was less than 70 millimeters.
Patients had to have 3 to 4 plus mitral regurgitation. They were New York Heart Association Classification II to IV. They were not appropriate for mitral valve surgery, but were accepted by interventional cardiologists for the likelihood for a successful mitral clip procedure. So, what were the principal findings? Hospitalization for heart failure at 24 months, 36% in the mitral valve clip plus medical management group and 68% in the medical group.
The safety endpoint for the device-related complications at 12 months was a modest 3%. What about some secondary outcomes for the mitral valve clip and medical treatment versus medical treatment? All-cause mortality, cardiovascular death 29% in the mitral valve patients, 46% in the medical treated group alone at 2 years. The severity of mitral regurgitation in the mitral clip group was reduced by two grades.
Left ventricular dimensions improved in the mitral clip group. The quality of life measures noted moderate and substantial improved -- and were substantially improved at 24 months in the mitral valve medically treated group. Before proceeding with a take-home message, let me comment on a prior mitral clip trial that was published in December 2019, and that was the MITRA-FR trial. This trial design was quite similar to the COAPT trial.
However, it didn't show -- it did not show a benefit in the mitral clip group compared to the maximally medically treated group. I reviewed both these studies, and I think there are obvious reasons for these differences. The COAPT trial had a larger enrollment of patients. They had more severe mitral regurgitation in the COAPT trial. Patients in the COAPT trial had less dilated ventricles and left ventricular dysfunction. There was a reduced procedural complication by the operators, the interventional cardiologists placing the mitral valve clip, and they had a greater success in reducing mitral regurgitation.
So, what's my take-home message? I think if we paid very close attention and adopted the inclusion criteria in the COAPT trial, it has shown that transcatheter mitral valve approximation using mitral clip on a background of maximally tolerated medical treatment is superior to medical treatment alone in reducing heart failure hospitalizations and mortality in symptomatic heart failure patients with grade 3 to 4 functional mitral regurgitation.
I want to thank you for joining me, and I'll see you next time on Practice Impact Extra. >> We hope you enjoyed this podcast from McGraw-Hill. Subscribers to Access Cardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts, and have access to other special features. To subscribe or learn more, please visit accesscardiology.com.
