Trending Clinical Topic of the Week (September 29 to October 5): Mitral Regurgitation
Surprising and conflicting findings related to the use of a treatment device resulted in this week's top search term. Over the summer, the US Food and Drug Administration approved the third generation of the MitraClip system for transcatheter-based mitral valve repair. Then, in late summer, results of the MITRA-FR trial were presented at the European Society of Cardiology (ESC) Congress 2018. They revealed that treatment with MitraClip failed to shift outcomes for patients. Specifically, at 1 year, no difference in all-cause death or unplanned hospitalization for heart failure was noted between the MitraClip and medical therapy–alone groups. Although the study confirmed the safety and efficacy of the device, it did not show that correction of functional mitral regurgitation changed the prognosis for patients.
However, in a stunning reversal, the results of the COAPT trial were recently unveiled. That study found that the use of MitraClip reduced the risk for heart failure hospitalization within 24 months by 47%. The study also found that the rate of freedom from device-related complications at 12 months was 96.6%, far outpacing the 88% target. Furthermore, all 10 powered secondary outcomes favored the MitraClip group, including death and quality of life. Notably, the risk for all-cause death was cut by 38%. Experts have pointed out that, in weighing the results of the COAPT trial, MitraClip performed better than percutaneous coronary intervention for acute myocardial infarction or implantable cardioverter-defibrillators for heart failure.
With two notable trials that have conflicting results, all eyes are on a potential tiebreaker: RESHAPE-HF2, a European trial of around 400 patients. Those who care for patients with mitral regurgitation are considering all of the evidence and are probably eagerly watching to see the next development, resulting in this week's top trending clinical topic.
For more information on mitral regurgitation, read here.
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Cite this: Ryan Syrek. Trending Clinical Topics for October 2018 - Medscape - Nov 30, 2018.