Impact of Natriuretic Peptide and Prior Hospitalization in Patients With Severe Mitral Regurgitation: COAPT Trial

• Published in: Circulation. Cardiovascular interventions Vol. 18; no. 7; p. e015192
• Main Authors: Goel, Sachin S., Guha, Ashrith, Lindenfeld, JoAnn, Abraham, William T., Kar, Saibal, Kapadia, Samir R., Little, Stephen H., Lim, D. Scott, Reardon, Michael J., Kleiman, Neal S., Aiyer, Janani, Kotinkaduwa, Lak N., Mack, Michael J., Stone, Gregg W.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.2025
• Subjects: Aged; Aged, 80 and over; Biomarkers - blood; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - mortality; Cardiovascular Agents - therapeutic use; Female; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - mortality; Heart Failure - therapy; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hospitalization - statistics & numerical data; Humans; Male; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - blood; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - therapy; Natriuretic Peptide, Brain - blood; Patient Readmission; Peptide Fragments - blood; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Up-Regulation; heart failure; natriuretic peptides; mitral valve; hospitalization; clinical relevance
• ISSN: 1941-7640; 1941-7632; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.125.015192

BACKGROUND: The clinical significance of elevated baseline natriuretic peptide level and prior heart failure hospitalization (HFH) within the prior year in mitral transcatheter edge-to-edge repair outcomes is unclear. This analysis examined the impact of BNP (B-type natriuretic peptide) or NT-proBNP (N-terminal pro-B-type natriuretic peptide) and prior HFH on outcomes in patients with severe secondary mitral regurgitation. METHODS: The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) was a randomized controlled trial of subjects assigned to mitral valve transcatheter edge-to-edge repair with the MitraClip device versus guideline-directed medical therapy alone. COAPT patients were grouped by BNP/NT-proBNP levels and prior HFH within 1 year: (1) Mild heart failure (HF): no prior HFH with BNP/NT-proBNP<median; (2) Moderate HF: prior HFH with BNP/NT-proBNP<median or no prior HFH with BNP/NT-proBNP≥median; and (3) Severe HF: prior HFH and BNP/NT-proBNP≥median. The primary measures were 2-year rates of death or HFH. RESULTS: Of 572 patients, mild, moderate, and severe HF were present in 125 (21.9%), 288 (50.3%), and 159 (27.8%) patients, respectively. With guideline-directed medical therapy alone, the 2-year rates of death or HFH in mild, moderate, and severe HF were 56.4%, 60.5%, and 84.1%, respectively (Ptrend=0.001). These rates were 48.7% and 73.4% among patients with moderate HF and a prior HFH only versus elevated BNP/NT-proBNP≥median only (P=0.003). Mitral transcatheter edge-to-edge repair reduced death/HFH compared with guideline-directed medical therapy alone regardless of HF severity (Pinteraction=0.50). CONCLUSIONS: In patients with HF with severe secondary mitral regurgitation enrolled in the COAPT trial, 2-year rates of death/HFH were increased with an elevated baseline BNP/NT-proBNP≥median, and more so if HFH within 1 year prior had occurred. Treatment with mitral transcatheter edge-to-edge repair reduced all-cause mortality and HFH consistently in mild, moderate, and severe HF. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.