Abstract 9795: The Association Between Albumin and Outcomes in Heart Failure and Secondary Mitral Regurgitation: Insights From the COAPT Trial

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Background: Low serum albumin level is associated with increased morbidity and mortality in numerous chronic diseases, but the relationship between albumin and outcomes in heart failure (HF) and secondary mitral regurgitation (SMR) has not been previously described. Methods: The Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial was a multicenter, randomized, controlled, parallel-group, open-label study that evaluated the efficacy and safety of transcatheter edge-to-edge repair (TEER) with the MitraClip + guideline-directed medical therapy (GDMT) versus GDMT alone in patients with symptomatic HF and moderate-to-severe or severe SMR. Baseline serum albumin level was obtained at enrollment. Results: Among 614 patients enrolled in COAPT, 559 (91.0%) had a baseline albumin level (median 4.0 g/dL [interquartile range: 3.7-4.2 g/dL]). Patients with albumin <4.0 g/dL compared with ≥4.0 g/dL were older (mean 73.7 years vs. 70.6), more likely to have ischemic cardiomyopathy (65.0% vs. 555.2%) and a hospitalization within the prior year (72.9% vs. 62.9%). After multivariable adjustment, patients with albumin <4.0 g/dL compared to ≥4.0 g/dL had higher 2-year rates of all-cause mortality (41.7% vs. 28.8%; HR 1.46, 95% CI 1.06-2.02; p=0.022; Figure Panel A), but no significant differences in the composite of all-cause mortality or hospitalization for HF (HHF), HHF alone, or all-cause hospitalizations (all p>0.05; Figure Panel B). There were no significant interactions between albumin and the relative efficacy of TEER + GDMT versus GDMT alone with respect to clinical outcomes (all p-interactions >0.05; Figure Panel B). Conclusions: In patients with HF and severe SMR enrolled in the COAPT trial, low serum albumin levels were common and were an independent predictor of mortality. MitraClip treatment provided a similar benefit regardless of baseline albumin level.