COAPT update: How AFib affects TMVR outcomes
Transcatheter mitral valve repair (TMVR) outcomes are worse when patients present with a history of atrial fibrillation (AFib), according to new research published in Circulation: Cardiovascular Interventions. However, TMVR still appeared to benefit those patients—and it was even linked with a decreased risk of stroke.
The study’s authors explored data from the renowned COAPT trial, which examined the safety and effectiveness of TMVR with the MitraClip device after two years. All COAPT participants presented with heart failure and moderate-to-severe or severe functional mitral regurgitation (MR). They then either underwent TMVR and guideline-directed medical therapy (GDMT) or GDMT alone.
For this updated analysis, the team focused on 327 patients from the COAPT trial with a history of AFib and another 287 patients who did not have AFib. The study’s primary outcome was the composite rate of death or heart failure hospitalization after two years.
Overall, patients with a history of AFib had higher left ventricular ejection fraction (LVEF), larger left atrial volumes and mitral valve orifice areas, smaller left ventricular volumes and similar MR volumes when compared to patients with no history of AFib. Looking at the study’s primary outcome, the rate of death or heart failure hospitalization after two years was 61.3% for AFib patients and 49.8% for patients without AFib.
Patients with AFib did still benefit from TMVR, the authors noted. Death or heart failure hospitalization after two years was significantly less common among AFib patients who underwent TMVR and GDMT (52.1%) than AFib patients who only underwent GDMT (71.6%).
In addition, the risk of a stroke within two years was much lower among patients with a history of AFib who underwent TMVR with the MitraClip device. This finding was not true for patients without AFib who underwent TMVR, and researchers said this trend required further research.
“We examined several possible explanations for this finding, including differences in medical therapy, left atrial dimensions, and heart rhythm,” wrote lead author Zachary M. Gertz, MD, VCU Pauley Heart Center in Richmond, Virginia, and colleagues. “There were numerically more patients treated with anticoagulation during follow-up in the device group, possibly due to the paradoxically increased rates of AFib observed in the MitraClip group during follow-up. Although these differences in anticoagulation use did not reach statistical significance, it is possible that better medical therapy for stroke prevention may have contributed to the lower incidence of stroke with TMVR.”
Numerous authors who contributed to this study reported receiving funding or consulting fees from Abbott Vascular, the company behind MitraClip. Abbott also funded the original COAPT trial.
Also: Back in January, CMS announced that TMVR would be known as transcatheter edge-to-edge repair (TEER) going forward. For the sake of clarity, this article refers to the procedure as TMVR instead of TEER to provide consistency with the analysis.
Click here to read the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.