ESC Congress in Review - Main Edition 2019 - 23

ESC Congress 2019 In Review

(24%) after CABG. The corresponding HR of 1.17 (95%
CI, 0.97 to 1.41, P = .092) was not significant. In the 3VD
subgroup, more patients died after PCI compared with
CABG (28% vs 21%, HR, 1.41; 95% CI, 1.10 to 1.80; P = .006).
In patients with LMCAD, there were no significant differences in death between PCI and CABG (26% vs 28%,
HR, 0.90; 95% CI, 0.68 to 1.20; P = .47). This treatmentby-subgroup interaction was statistically significant,
indicating a potential benefit for CABG in more complex
coronary disease (P interaction = .019). There was no
difference in outcomes based on the presence or
absence of diabetes (HR, 1.10; 95% CI, 0.80 to 1.52 vs
HR, 1.20; 95% CI, 0.96 to 1.51; P interaction = .66). In
addition, there was no relationship between SYNTAX
score tertiles and outcomes (P trend = .30).
Gregg Stone, MD, PhD, Columbia University Medical
Center/NewYork-Presbyterian and the Cardiovascular
Research Foundation, New York, USA, commented on the
SYNTAXES results during the same session. He argued
that a multidisciplinary heart team has numerous factors to weigh, in concert with patient preferences, when
choosing between PCI and CABG in complex coronary
artery disease. Short-term advantages of PCI include
the less invasive nature of this procedure, which also
has fewer peri-procedural complications and is followed
by a more rapid recovery with a better early quality of
life and earlier angina relief. CABG has more long-term
advantages, notably fewer late myocardial infarcts and
fewer repeat revascularisation procedures. Long-term
survival depends, among others, on clinical and anatomic factors, operator expertise, and completeness of
revascularisation.
Replay presentation on ESC365

2-Year Outcome MITRA-FR
shows no Benefit Percutaneous
Mitral Valve Repair
Written by Michiel Tent

After 2 years of follow-up, percutaneous repair with the
MitraClip still did not improve the prognosis of patients
with secondary mitral regurgitation in the Multicentre
Study of Percutaneous Mitral Valve Repair MitraClip Device
in Patients With Severe Secondary Mitral Regurgitation
[MITRA-FR; Obadia JF et al. N Engl J Med 2018] trial. These
results are in contrast to findings of the COAPT study
[Stone GW et al. N Engl J Med 2018] in which percutaneous
mitral valve repair significantly reduced heart failure (HF)
rehospitalisation and death after 2 years.
MITRA-FR was an academically-led, prospective,
multicentre, randomised controlled, open-label trial performed in France. Participants had chronic HF, severe
secondary mitral regurgitation (i.e., regurgitation volume
> 30 mL/beat and/or a regurgitant orifice area > 20 mm2),

and reduced left ventricular function ejection fraction
(LVEF; 15 to 40%), who were symptomatic (NYHA class ≥ II)
despite guideline-directed medical treatment and had
been hospitalised for an HF event within the previous 12
months. A total of 304 eligible patients (70 ± 10 years,
74% males) were randomised from 37 centres. Patients
underwent either percutaneous valve repair plus medical treatment (intervention group, n = 152) or medical
treatment alone (control group, n = 152). The primary
efficacy outcome was the composite of all-cause death
and unplanned hospitalisation for HF at 12 months.
Principal investigator Jean-François Obadia, MD, PhD,
Hospices Civils de Lyon, France, presented the 2-year
results [Iung B et al. Eur J Heart Fail. 2019]. At baseline,
most patients were severely symptomatic (67% in NYHA
class ≥ III), STS score for mortality was 5.7 ± 6.7%, LVEF
was 33 ± 7%, regurgitant volume was 45 ± 14 ml, and
regurgitant orifice area was 31 ± 11 mm2 at baseline. At
24 months, the primary efficacy outcome of all-cause
death and unplanned hospitalisations for HF occurred in
63.8% (97/152) and 67.1% (102/152) of the intervention
and control group, respectively (HR, 1.01; 95% CI, 0.77
to 1.34). There were no significant differences between
groups, whether the outcomes were analysed together
or separately. Rates of all-cause mortality were 34.9%
(53/152) and 34.2% (52/152) in the intervention and control groups, respectively (HR, 1.02; 95% CI, 0.70 to 1.50).
Unplanned hospitalisation for heart failure occurred in
55.9% (85/152) and 61.8% (94/152) of patients, respectively (HR, 0.97; 95% CI, 0.72 to 1.30). Prof. Obadia also
observed that percutaneous repair remained safe, with
only a small number of prespecified serious adverse
events related to it. Between 12 months and 24 months,
4 serious adverse events occurred in the intervention
group and 7 in the control group.
An exploratory post-hoc analysis of events occurring
between 12 and 24 months suggested a lower rate of
first hospitalisation for HF in the intervention group (HR,
0.47; 95% CI, 0.22 to 0.98), Prof. Obadia added. This
trend was consistent with a divergence in the curves of
recurrent hospitalisations for HF for each group. This is
the rationale for 2 complementary studies that will be
performed: a 5-year follow-up of the MITRA-FR cohort,
and a meta-analysis on individual data of the MITRA-FR
and COAPT studies.
Discussant Rebecca Hahn, MD, Columbia University
Medical Center/New York-Presbyterian, New York City, USA,
discussed the differences in MITRA-FR and COAPT trial
outcomes. She noted that the 2 trials are in fact concordant. She hypothesised that patients might be more likely
to benefit from the MitraClip if they have truly severe secondary mitral regurgitation without excessive left ventricular dilatation, while receiving optimal guideline-directed
medical treatment.
Replay presentation on ESC365

Official Peer-Reviewed Highlights From ESC Congress 2019

https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/Hot-Line-Session-4/202178-syntaxes-ten-year-survival-after-coronary-artery-bypass-grafting-versus-percutaneous-coronary-intervention-the-syntax-extended-survival-study https://esc365.escardio.org/Congress/ESC-CONGRESS-2019/Hot-Line-Session-4/202179-mitra-fr-2-years-follow-up-of-the-mitra-fr-study-a-randomized-controlled-trial-evaluating-the-effectiveness-of-percutaneous-mitral-valve-repair-in-secondary-mitral-regurgitation

ESC Congress in Review - Main Edition 2019

Table of Contents for the Digital Edition of ESC Congress in Review - Main Edition 2019