Key result
In patients treated with MitraClip, ischaemic mitral regurgitation had a similar risk of death or heart failure hospitalization compared to non-ischaemic MR (OR 1.17; 95% CI 0.93-1.46).
Why the study?
Randomized trials evaluating MitraClip added to GDMT in secondary mitral regurgitation showed conflicting results, and whether differences could be due to underlying MR aetiology remained unknown.
Does percutaneous edge-to-edge repair with MitraClip implantation yield different outcomes in patients with ischaemic versus non-ischaemic secondary mitral regurgitation?
Meta-Analysis (n=2,501)
Does percutaneous edge-to-edge repair with MitraClip implantation yield different outcomes in patients with ischaemic versus non-ischaemic secondary mitral regurgitation?
Odds Ratio: 1.17 (95% CI 0.93–1.46)
Following MitraClip implantation for secondary mitral regurgitation, patients with an ischaemic aetiology have a higher risk of all-cause mortality compared to those with a non-ischaemic aetiology, though the risk of heart failure hospitalization is similar.
Ischaemic aetiology signals higher post-MitraClip mortality in secondary MR; extends aetiology-specific prognostic data.
Aim Randomized controlled trials comparing the use of the MitraClip device in addition to guideline directed medical therapy (GDMT) to GDMT alone in patients with secondary mitral regurgitation (MR) have shown conflicting results. However, if these differences could be due to the underlying MR aetiology is still unknown. Therefore, we aimed to evaluate if the effects of percutaneous edge-to-edge repair with MitraClip implantation could differ in patients with ischaemic (I-MR) and non-ischaemic mitral regurgitation (NI-MR). Methods and results PubMed, Embase, BioMed Central, and the Cochrane Central Register of Controlled Trials were searched for all studies including patients with secondary MR treated with the MitraClip device. Data were pooled using a random-effects model. Primary endpoint was the composite of all-cause death and heart failure-related hospitalization. Secondary endpoints were the single components of the primary endpoint, New York Heart Association functional Classes III and IV, and mitral valve re-intervention. Seven studies enrolling 2501 patients were included. Patients with I-MR compared with patients with NI-MR had a similar risk of the primary endpoint (odds ratio: 1.17; 95% confidence interval: 0.93 to 1.46; I2: 0%). The risk of all-cause death was increased in patients with I-MR (odds ratio: 1.31; 95% confidence interval: 1.07 to 1.62; I2: 0%), while no differences were observed between the two groups in terms of the other secondary endpoints. Conclusions The risk of mortality after MitraClip implantation is lower in patients with NI-MR than in those with I-MR. No absolute differences in the risk of heart failure related hospitalization were observed between groups.
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Chiarito et al. (2022) conducted a meta-analysis in secondary mitral regurgitation (n=2,501). Ischaemic mitral regurgitation (I-MR) vs. Non-ischaemic mitral regurgitation (NI-MR) was evaluated on composite of all-cause death and heart failure-related hospitalization (OR 1.17, 95% CI 0.93 to 1.46). In patients treated with MitraClip, ischaemic mitral regurgitation had a similar risk of death or heart failure hospitalization compared to non-ischaemic MR (OR 1.17; 95% CI 0.93-1.46).
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