Citation: New England Journal of Medicine. 379(24):2307-2318, 2018 12 13..Journal: The New England journal of medicine.Published: ; 2018ISSN: 0028-4793.Full author list: Lindenfeld J; Abraham WT; Kar S; Lim DS; Mishell JM; Whisenant B; Grayburn PA; Rinaldi M; Kapadia SR; Rajagopal V; Sarembock IJ; Brieke A; Marx SO; Cohen DJ; Weissman NJ; Mack MJ; COAPT Investigators.UI/PMID: 30280640.Subject(s): Aged | Aged, 80 and over | Combined Modality Therapy | Female | Heart Failure/et [Etiology] | Heart Failure/mo [Mortality] | Heart Failure/su [Surgery] | Heart Valve Prosthesis/ae [Adverse Effects] | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Heart Valve Prosthesis Implantation | Hospitalization/sn [Statistics & Numerical Data] | Humans | Intention to Treat Analysis | Kaplan-Meier Estimate | Male | Middle Aged | Mitral Valve/su [Surgery] | Mitral Valve Insufficiency/dt [Drug Therapy] | Mitral Valve Insufficiency/mo [Mortality] | *Mitral Valve Insufficiency/su [Surgery] | Percutaneous Coronary Intervention | Prosthesis Failure | Stroke Volume | Treatment Outcome | Ventricular Dysfunction, Left/et [Etiology]=190 \\ Stone GWInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access onlineDigital Object Identifier: https://dx.doi.org/10.1056/NEJMoa1806640 (Click here)Abbreviated citation: N Engl J Med. 379(24):2307-2318, 2018 12 13.Local Holdings: Available online from MWHC library: 1993 - present, Available in print through MWHC library: 1980 - present.Abstract: BACKGROUND: Among patients with heart failure who have mitral regurgitation due to left ventricular dysfunction, the prognosis is poor. Transcatheter mitral-valve repair may improve their clinical outcomes.Abstract: METHODS: At 78 sites in the United States and Canada, we enrolled patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy. Patients were randomly assigned to transcatheter mitral-valve repair plus medical therapy (device group) or medical therapy alone (control group). The primary effectiveness end point was all hospitalizations for heart failure within 24 months of follow-up. The primary safety end point was freedom from device-related complications at 12 months; the rate for this end point was compared with a prespecified objective performance goal of 88.0%.Abstract: RESULTS: Of the 614 patients who were enrolled in the trial, 302 were assigned to the device group and 312 to the control group. The annualized rate of all hospitalizations for heart failure within 24 months was 35.8% per patient-year in the device group as compared with 67.9% per patient-year in the control group (hazard ratio, 0.53; 95% confidence interval [CI], 0.40 to 0.70; P<0.001). The rate of freedom from device-related complications at 12 months was 96.6% (lower 95% confidence limit, 94.8%; P<0.001 for comparison with the performance goal). Death from any cause within 24 months occurred in 29.1% of the patients in the device group as compared with 46.1% in the control group (hazard ratio, 0.62; 95% CI, 0.46 to 0.82; P<0.001).Abstract: CONCLUSIONS: Among patients with heart failure and moderate-to-severe or severe secondary mitral regurgitation who remained symptomatic despite the use of maximal doses of guideline-directed medical therapy, transcatheter mitral-valve repair resulted in a lower rate of hospitalization for heart failure and lower all-cause mortality within 24 months of follow-up than medical therapy alone. The rate of freedom from device-related complications exceeded a prespecified safety threshold. (Funded by Abbott; COAPT ClinicalTrials.gov number, NCT01626079 .).