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

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 2years. RESULTS: The analysis included 1185 consecutive patients with secondary mitral regurgitation treated with M-TEER between January 2016 and March 2020 (median age 74years). 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.