Transcatheter edge-to-edge repair (TEER) with the MitraClip device provides improved outcomes for both male and female heart failure (HF) patients with secondary mitral regurgitation (SMR), according to a new study published in JACC: Heart Failure. The long-term effect of TEER, however, is more evident in men.
Researchers tracked data from the previously completed COAPT trial, focusing on 614 HF patients who presented with moderate-to-severe or severe SMR. Patients either received guideline-directed medical therapy (GDMT) or TEER, formerly known as transcatheter mitral valve repair (TMVR), plus GDMT.
Thirty-six percent of patients included in the analysis were women. The women tended to be younger than the male patients and had fewer comorbidities. They did have more severe HF symptoms, however, and a poor quality of life. Men, on the other hand, were more likely to present with a history of coronary artery disease, myocardial infarction, previous coronary revascularization, arrhythmias, renal dysfunction or hypercholesterolemia.
Overall, after two years, TEER with the MitraClip combined with GDMT was associated with “consistent improvements” in the health of both men and women. The TEER procedures also had high success rates for both men and women.
Men treated with GDMT alone had higher annual heart failure hospitalization (HFH) rates than women treated with GDMT alone (73.1% vs. 55.1%). Among the patients treated with TEER/TMVR, however, annual HFH rates were higher among women than men (42.4% vs. 30.5%).
The team also found that, using “joint frailty model accounting for the competing risk of death,” recurrent HFHs were more common among men in the GDMT group. The rates were similar between the two sexes in the TEER group.
Unadjusted two-year data, meanwhile, found “no significant interactions between sex and treatment modality” when it came to HFHs, other hospitalizations, cardiovascular mortality or all-cause mortality.
“The development of severe SMR connotes a poor prognosis in patients with HF, and recent reports have indicated a higher incidence of SMR in men with HF compared with women,” wrote first author Ioanna Kosmidou, MD, PhD, a cardiologist at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center in New York City, and colleagues.
“However, to our knowledge, no previous study has examined the sex-specific effects of SMR and its treatment on long-term prognosis in HF. The current analysis from the randomized COAPT trial demonstrates that the outcomes of both sexes were substantially improved after [TEER] with the MitraClip compared with GDMT alone. Procedural success rates were high, and device-related complications were infrequent, and did not differ between sexes, confirming previous reports of [TEER] safety irrespective of sex.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.