Age-Related Outcomes After Transcatheter Mitral Valve Repair in Patients With HeartFailure: Analysis From COAPT.

Abstract

The aim of this study was to assess the impact of age on outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for HeartFailure Patients with Functional Mitral Regurgitation) trial. In the COAPT trial, TEER with the MitraClip device in patients with heart failure (HF) and moderate to severe or severe secondary mitral regurgitation (SMR) reduced the risk for HF hospitalization (HFH) and all-cause mortality compared with maximally tolerated guideline-directed medical therapy (GDMT) alone. There are limited data regarding the effectiveness of MitraClip therapy in elderly patients. Patients (n=614) were grouped by median age at randomization (74 years) and by MitraClip treatment vs GDMT alone. The primary endpoint was the 2-year rate of death or HFH assessed by multivariable Cox regression. Death or HFH within 2 years occurred less frequently after treatment with the MitraClip vs GDMT alone in patients<74 years of age (37.3% vs 64.5%; adjusted HR: 0.41; 95%CI: 0.29-0.59) and≥74 years of age (51.7% vs 69.6%; adjusted HR: 0.58; 95%CI: 0.42-0.81) (Pint=0.17). Mortality was also consistently reduced with MitraClip treatment in young and elderly patients (Pint=0.42). In contrast, elderly patients treated with the MitraClip vs GDMT alone tended to have a lesser reduction of HFH than younger patients (Pint=0.03). Younger and older patients had similar improvements in quality of life after treatment with the MitraClip compared with GDMT alone. In the COAPT trial, MitraClip treatment of moderate to severe and severe SMR reduced the composite risk for death or HFH and improved survival and quality of life regardless of age. As such, young and elderly patients with HF and severe SMR benefit from TEER, although elderly patients may not have as great a benefit from the MitraClip device in reducing HFH.