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Cerebrovascular Events After Transcatheter Edge-to-Edge Repair and Guideline-Directed Medical Therapy in the COAPT Trial.

Vincent, Flavien (author)
Redfors, Björn (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
Kotinkaduwa, Lak N (author)
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Kar, Saibal (author)
Lim, D Scott (author)
Mishell, Jacob M (author)
Whisenant, Brian K (author)
Lindenfeld, JoAnn (author)
Abraham, William T (author)
Mack, Michael J (author)
Stone, Gregg W (author)
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 (creator_code:org_t)
2023
2023
English.
In: JACC. Cardiovascular interventions. - 1936-8798 .- 1876-7605. ; 16:12, s. 1448-1459
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Little is known regarding the risk of cerebrovascular events (CVE) in patients with heart failure and severe secondary mitral regurgitation treated with transcatheter edge-to-edge repair (TEER).The study sought to examine the incidence, predictors, timing, and prognostic impact of CVE (stroke or transient ischemic attack) in the COAPT (Cardiovascular Outcomes Assessment of the Mitraclip Percutaneous Therapy for HeartFailure Patients with Functional Mitral Regurgitation) trial.A total of 614 patients with heart failure and severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) vs GDMT alone.At 4-year follow-up, 50 CVEs occurred in 48 (7.8%) of the 614 total patients enrolled in the COAPT trial; Kaplan-Meier event rates were 12.3% in the TEER group and 10.2 in the GDMT alone group (P=0.91). Within 30days of randomization, CVE occurred in 2 (0.7%) patients randomized to TEER and 0% randomized to GDMT (P=0.15). Baseline renal dysfunction and diabetes were independently associated with increased risk of CVE, while baseline anticoagulation was associated with a reduction of CVE. A significant interaction was present between treatment group and anticoagulation such that TEER compared with GDMT alone was associated with a reduced risk of CVE among patients with anticoagulation (adjusted HR: 0.24; 95%CI: 0.08-0.73) compared with an increased risk of CVE in patients without anticoagulation (adjusted HR: 2.27; 95%CI: 1.08-4.81; Pinteraction=0.001). CVE was an independent predictor of death within 30days after the event (HR: 14.37; 95%CI: 7.61, 27.14; P< 0.0001).In the COAPT trial, the 4-year rate of CVE was similar after TEER or GDMT alone. CVE was strongly associated with mortality. Whether anticoagulation is effective at reducing CVE risk after TEER warrants further study.(Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for HeartFailure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT); NCT01626079).

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Humans
Mitral Valve Insufficiency
diagnostic imaging
surgery
Treatment Outcome
Heart Failure
epidemiology
therapy
Ischemic Attack
Transient
Anticoagulants

Publication and Content Type

ref (subject category)
art (subject category)

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