Sachin S Goel, Ashrith Guha, JoAnn Lindenfeld, William T Abraham, Saibal Kar, Samir R Kapadia, Stephen H Little, D Scott Lim, Michael J Reardon, Neal S Kleiman, Janani Aiyer, Lak Kotinkaduwa, Michael Mack, Gregg W Stone
{"title":"利钠肽对严重二尖瓣返流患者的影响及既往住院：COAPT试验。","authors":"Sachin S Goel, Ashrith Guha, JoAnn Lindenfeld, William T Abraham, Saibal Kar, Samir R Kapadia, Stephen H Little, D Scott Lim, Michael J Reardon, Neal S Kleiman, Janani Aiyer, Lak Kotinkaduwa, Michael Mack, Gregg W Stone","doi":"10.1161/CIRCINTERVENTIONS.125.015192","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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 N-terminal prohormone BNP NT-proBNP (N-terminal pro-B-type natriuretic peptide) and prior HFH on outcomes in patients with severe secondary mitral regurgitation.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>P</i><sub>trend</sub>=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 (<i>P</i>=0.003). Mitral transcatheter edge-to-edge repair reduced death/HFH compared with guideline-directed medical therapy alone regardless of HF severity (<i>P</i><sub>interaction</sub>=0.50).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e015192"},"PeriodicalIF":6.1000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Natriuretic Peptide and Prior Hospitalization in Patients With Severe Mitral Regurgitation: COAPT Trial.\",\"authors\":\"Sachin S Goel, Ashrith Guha, JoAnn Lindenfeld, William T Abraham, Saibal Kar, Samir R Kapadia, Stephen H Little, D Scott Lim, Michael J Reardon, Neal S Kleiman, Janani Aiyer, Lak Kotinkaduwa, Michael Mack, Gregg W Stone\",\"doi\":\"10.1161/CIRCINTERVENTIONS.125.015192\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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 N-terminal prohormone BNP NT-proBNP (N-terminal pro-B-type natriuretic peptide) and prior HFH on outcomes in patients with severe secondary mitral regurgitation.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>P</i><sub>trend</sub>=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 (<i>P</i>=0.003). Mitral transcatheter edge-to-edge repair reduced death/HFH compared with guideline-directed medical therapy alone regardless of HF severity (<i>P</i><sub>interaction</sub>=0.50).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT01626079.</p>\",\"PeriodicalId\":10330,\"journal\":{\"name\":\"Circulation: Cardiovascular Interventions\",\"volume\":\" \",\"pages\":\"e015192\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2025-05-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015192\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.125.015192","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Impact of Natriuretic Peptide and Prior Hospitalization in Patients With Severe Mitral Regurgitation: COAPT Trial.
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 N-terminal prohormone BNP 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
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.
期刊介绍：
Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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