Background

The mechanisms and prognosis of secondary mitral regurgitation (MR) may be different in patients (pts) with ischemic (ICM) and nonischemic cardiomyopathy (NICM). Whether transcatheter mitral valve repair with MitraClip is equally effective in ICM and NICM is unknown.

Methods

In COAPT, 614 pts with heart failure (HF) and 3+ or 4+ MR who remained symptomatic despite maximally-tolerated guideline-directed medical therapy (GDMT) were randomized to MitraClip plus GDMT vs GDMT alone. We examined outcomes according to ICM vs NICM.

Results

ICM and NICM were present in 373 (60.7%) and 241 (39.3%) pts respectively. ICM pts were older, more frequently male and had a higher STS risk score compared with NICM pts (all p<0.0001). ICM pts also had smaller left ventricles (LVs) (mean LV end-diastolic volume index 98.5 mL/m2 vs 106 mL/m2, p=0.01) and greater mean LVEF (32.4% vs 29.6%, p=0.0005). In the device group, there were no differences in the mean number of clips used in ICM and NICM (1.7 vs 1.6, p=0.38) or core lab MR grade £2+ at 24 months (99% vs 100.0%, p=0.41). In all pts, there was no significant difference in the 2-year rate of death or HF hospitalization (HFH) in pts with ICM vs NICM (42.8% vs 39.2%, p=0.63). Treatment with MitraClip compared with GDMT alone consistently improved outcomes in ICM and NICM (Table).

Conclusion

Despite baseline differences in pts with ICM and NICM and severe secondary MR, both etiologies demonstrated substantial improvement after MitraClip treatment at 24 months.

Footnotes