Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial

Scotti, A; Coisne, A; Granada, JF; Driggin, E; Madhavan, MV; Zhou, Z; Redfors, B; Kar, S; Lim, DS; Cohen, DJ; Lindenfeld, J; Abraham, WT; Mack, MJ; Asch, FM; Stone, GW

doi:10.1016/j.jacc.2023.04.047

Valvular & structural heart disease

Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial

J Am Coll CardiolPublished 9 Jun 2023Secondary analysis of the COAPT randomised trial

Primary result · All-cause mortalityResultAdj-HR 1.37 95% CI 1.03–1.82

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Authors' conclusion

Malnutrition was present in 1 of 6 patients with HF and severe SMR enrolled in COAPT and was independently associated with increased 4-year mortality (but not HFH). TEER reduced mortality and HFH in patients with and without malnutrition.

Study context

Population: Heart failure (HF) patients with severe secondary mitral regurgitation randomised to transcatheter edge-to-edge repair (TEER) with MitraClip plus guideline-directed medical therapy (GDMT) vs GDMT alone
Participants: 552 patients

Comparison: Malnutrition vs no malnutrition
Malnutritionn = 94
Primary endpoint: All-cause mortality
Follow-up: 4 years

Primary result

As reported in the abstract

Adj-HR

1.37

95% CI 1.03–1.82

P = 0.03

By group

Malnutrition68.3%

No malnutrition52.8%

Malnutrition vs No malnutrition

adj-HR 1.37 (95% CI 1.03–1.82); P = 0.03

Further findings

Outcome	← Lower vs GDMT alone ←→ Higher vs GDMT alone →	adj-HR (95% CI)	P value
4-year mortality, TEER plus GDMT vs GDMT alone · multivariable	0.20.5125	0.65 (0.51–0.82)	P = 0.0003
HF hospitalisation · 4 yearsTEER vs GDMT alone	0.20.5125	0.46 (0.36–0.56)
	0.20.5125Adj-HR (log scale)

4-year mortality, TEER plus GDMT vs GDMT alone: consistent with and without malnutrition, adj-Pinteraction = 0.46
HF hospitalisation: consistent with and without malnutrition, adj-Pinteraction = 0.67

Prevalence of malnutrition and baseline geriatric nutritional risk index (GNRI) · median Baseline

Malnutrition: 94 (17.0%)
Median baseline GNRI: 109 (IQR: 101-116)

HF hospitalisation · 4 years

GNRI unrelated to 4-year heart failure hospitalization (HFH) rate

Original publication

Impact of Malnutrition in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT Trial. J Am Coll Cardiol. Published 9 June 2023. doi:10.1016/j.jacc.2023.04.047

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Summarised from the published abstract; every number is checked against it