Estimating the Effects of MTEER in U.S. Practice: A Transportability Analysis of the COAPT Trial (JACC October 2026-2)-Article: Estimating the Effects of MTEER in U.S. Practice: A Transportability Analysis of the COAPT Trial

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This study examined whether the benefits of mitral transcatheter edge-to-edge repair (MTEER) found in the COAPT trial would apply to patients treated in contemporary U.S. practice. Researchers used data from 614 COAPT participants and 15,275 patients in the STS/ACC TVT Registry who received MTEER for secondary mitral regurgitation between 2019 and 2023. They used inverse-probability weighting to estimate COAPT treatment effects in two registry-based groups: patients meeting COAPT eligibility criteria and the broader population treated in practice.<br /><br />Registry patients differed substantially from COAPT participants. They were less likely to have ischemic cardiomyopathy and more likely to have severe mitral regurgitation and advanced symptoms. Nevertheless, estimated reductions in 2-year heart-failure hospitalization were similar to COAPT’s: 17.0 percentage points in the trial-eligible population and 19.1 points in the broader treatment-candidate population, versus 19.2 points in the original trial. In the trial-eligible group, estimated all-cause mortality was also reduced by 15.4 percentage points. Differences between transported and original trial effects were not statistically significant.<br /><br />The findings suggest that COAPT’s benefits may extend to patients treated in U.S. practice if they receive the trial’s full package of care, including optimized guideline-directed medical therapy—not MTEER alone. Interpretation depends on assumptions that relevant patient characteristics were measured and that comparable patients were represented in both datasets. Important echocardiographic measures and other factors were unavailable or incomplete. The results therefore do not establish that outcomes in routine care match those achieved in COAPT.

Meta Tag

Concept Transportability Analysis

Concept COAPT Trial

Concept Secondary Mitral Regurgitation

Concept Mitral Clip Procedure

Concept Randomized Clinical Trial

Keywords

mitral transcatheter edge-to-edge repair

MTEER

COAPT trial

secondary mitral regurgitation

heart-failure hospitalization

all-cause mortality

STS/ACC TVT Registry

inverse-probability weighting

guideline-directed medical therapy

comparative effectiveness

Transportability Analysis

COAPT Trial

Secondary Mitral Regurgitation

Mitral Clip Procedure

Randomized Clinical Trial