Short-term improvement after mitral valve repair may signify long-term benefits: COAPT
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Positive changes in disease-specific health status as soon as 1 month after transcatheter mitral valve repair were strongly linked to reduced long-term risk for HF hospitalization or death, according to a new analysis of the COAPT trial presented at the American College of Cardiology Scientific Session.
“For a procedure that may result in early health status benefits as well as later improvements in clinical outcomes, it is useful to know that those patients with early improvement in health status are also more likely to derive long-term clinical benefits,” Suzanne V. Arnold, MD, cardiologist at St. Luke’s Mid America Heart Institute in Kansas City, Missouri, associate professor of medicine at University of Missouri-Kansas City and a Cardiology Today Next Gen Innovator, and colleagues wrote in the study, which was simultaneously published in the Journal of the American College of Cardiology.
COAPT trial
As Healio previously reported in 2018, patients with HF with moderate to severe or severe functional mitral regurgitation who underwent transcatheter mitral valve repair reduced their risk for HF hospitalization and mortality compared with patients treated with medical therapy alone at 2 years. The treatment effect of transcatheter mitral valve repair in these patients was even greater at 3 years than it was at 2 years.
In this analysis, researchers analyzed data from 551 patients (mean age, 72 years; 36% women; mean left ventricular ejection fraction, 31%) with HF and severe secondary mitral regurgitation who survived 1 month after mitral valve repair. HF-specific health status based on the Kansas City Cardiomyopathy Questionnaire (KCCQ) was evaluated at 1, 6, 12 and 24 months.
At 1 month, patients assigned transcatheter mitral valve repair had at least a moderate improvement in health status compared with those assigned guideline-directed medical therapy (58.4% vs. 26.1%).
Patients with moderate and large health status improvements at 1 month had lower rates of the composite of HF hospitalization or death between 1 month (40.2%) and 2 years (39.2%) vs. those with no change (57%), small improvement (64.6%) or worse health status (63.8%; P for log-rank < .001).
Each 10-point increase in KCCQ score was linked to a 14% lower risk for HF hospitalization or death (HR = 0.86; 95% CI, 0.81-0.92). No interaction was observed with treatment groups (P for interaction = .17).
The link between a change in KCCQ score and outcomes was strengthened after adjusting for clinical and demographic factors (HR = 0.75; 95% CI, 0.69-0.82).
Identifying high-risk patients
“Conversely, by identifying transcatheter mitral valve repair nonresponders at an early timepoint, 1 month change in the KCCQ overall summary score can identify a subset of patients who are at relatively high risk for poor long-term clinical outcomes,” Arnold and colleagues wrote. “This knowledge could not only inform discussions about prognosis with the patient and their family but could also trigger consideration of other advanced HF therapies such as left ventricular assist device or cardiac transplantation.” – by Darlene Dobkowski
References:
Arnold SV, et al. Highlighted Original Research: Interventional Cardiology and the Year in Review. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Arnold SV, et al. J Am Coll Cardiol.2020;doi:10.1016/j.jacc.2020.03.002.
Disclosures: The COAPT trial was sponsored by Abbott. Arnold reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.