Competing Risks of Cardiac and Noncardiac Mortality in Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.

BACKGROUND

The relative impact of cardiac and noncardiac mortality in patients with secondary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER) has been poorly investigated. We aimed to assess the competing risks and independent predictors of cardiac and noncardiac mortality in a real-world secondary mitral regurgitation population treated with M-TEER and included in the GIOTTO (Italian Society of Interventional Cardiology [GIse] Registry Of Transcatheter Treatment of Mitral Valve Regurgitation) registry.

METHODS

Competing risks analysis was used to assess the cumulative incidence of cardiac and noncardiac mortality. Cox regression identified independent predictors of each outcome. Co-primary outcomes were cardiac and noncardiac death at 2 years.

RESULTS

The analysis included 1185 consecutive patients with secondary mitral regurgitation treated with M-TEER between January 2016 and March 2020 (median age 74 years). Two-year cumulative incidences of cardiac and noncardiac mortality were 19% and 12%, respectively. At multivariable analysis, predictors of cardiac mortality were age (hazard ratio [HR], 1.03; P=0.002), New York Heart Association class (HR, 1.44; P=0.018), previous hospitalization for heart failure (HR, 1.67; P=0.016), hemoglobin (HR, 0.89; P=0.016), left ventricular end-diastolic diameter (HR, 1.02; P=0.025), left ventricular ejection fraction (HR, 0.98; P=0.022), and daily furosemide dose (HR, 1.19; P=0.003). Predictors of noncardiac mortality were New York Heart Association class (HR, 1.70; P=0.03), estimated glomerular filtration rate (HR, 0.98; P=0.002), and smoking habit (HR, 1.82; P=0.009).

CONCLUSIONS

Patients with secondary mitral regurgitation treated with M-TEER show a high 2-year incidence of both cardiac and noncardiac mortality. Understanding competing risks of mortality may improve patient selection for M-TEER.