{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:57:58Z","timestamp":1785819478906,"version":"3.56.0"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,2,21]]},"abstract":"\n Background<\/jats:title>\n Peripheral artery disease (PAD) and heart failure (HF) often coexist. Whether PAD influences outcomes of transcatheter mitral valve repair (TMVr) in patients with HF and severe secondary mitral regurgitation is unknown. The objectives are to assess the impact of PAD on outcomes of TMVr plus guideline\u2010directed medical therapy (GDMT) versus GDMT alone in patients with HF and secondary mitral regurgitation.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) randomized patients with HF with \u2265moderate\u2010to\u2010severe secondary mitral regurgitation to TMVr with MitraClip implant plus GDMT versus GDMT alone. We evaluated the relationship between PAD and 2\u2010year outcomes in\n the COAPT trial<\/jats:underline>\n \u00a0and examined whether PAD modified the benefits of TMVr. Among 614 patients enrolled, 109 (17.8%) had PAD. By multivariable analysis, PAD was independently associated with 2\u2010year mortality (adjusted hazard ratio [adjHR], 1.51 [95% CI, 1.07\u20132.15]) but not HF hospitalizations. Compared with GDMT alone, TMVr reduced the 2\u2010year risk of death in patients without PAD (adjHR, 0.42 [95% CI, 0.30\u20130.60]) but not those with PAD (adjHR, 1.27 [95% CI, 0.72\u20132.27];\n P<\/jats:italic>\n interaction<\/jats:sub>\n =0.001). In contrast, TMVr reduced HF hospitalizations consistently in patients with (adjHR, 0.65 [95% CI, 0.35\u20131.23]) and without (adjHR, 0.42 [95% CI, 0.31\u20130.57]) PAD (\n P<\/jats:italic>\n interaction<\/jats:sub>\n =0.22). Improvements in health status and exercise capacity at 2\u2009years with TMVr compared with GDMT alone were similar in degree, irrespective of PAD status (\n P<\/jats:italic>\n interaction<\/jats:sub>\n =0.76 and 0.64, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In patients with HF and severe secondary mitral regurgitation, the reduced mortality with TMVr in the overall COAPT study population was not observed in the subgroup of patients with PAD. However, TMVr reduced HF hospitalizations and improved health status and exercise capacity consistently in patients with and without PAD.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n Clinical Trial Name: Cardiovascular Outocmes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (The COAPT Trial); URL:\n https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n ; Unique identifier: NCT01626079.\n https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01626079<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.122.028444","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T11:58:12Z","timestamp":1675857492000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Peripheral Artery Disease in Patients With Heart Failure Undergoing Transcatheter Mitral Valve Repair: The COAPT Trial"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5688-6101","authenticated-orcid":false,"given":"Bahira","family":"Shahim","sequence":"first","affiliation":[{"name":"Clinical Trials Center Cardiovascular Research Foundation New York NY"},{"name":"Division of Cardiology, Department of Medicine Solna Karolinska Institutet, Karolinska University Hospital Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9163-724X","authenticated-orcid":false,"given":"David J.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Clinical Trials Center Cardiovascular Research Foundation New York NY"},{"name":"St. Francis Hospital Roslyn NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ori","family":"Ben\u2010Yehuda","sequence":"additional","affiliation":[{"name":"Clinical Trials Center Cardiovascular Research Foundation New York NY"},{"name":"New York\u2010Presbyterian Hospital\/Columbia University Irving Medical Center NY New York"},{"name":"Division of Cardiology University of California \u2010 San Diego San Diego CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4155-4451","authenticated-orcid":false,"given":"Bj\u00f6rn","family":"Redfors","sequence":"additional","affiliation":[{"name":"Clinical Trials Center Cardiovascular Research Foundation New York NY"},{"name":"New York\u2010Presbyterian Hospital\/Columbia University Irving Medical Center NY New York"},{"name":"Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1547-4869","authenticated-orcid":false,"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Los Robles Regional Medical Center Thousand Oaks CA"},{"name":"Bakersfield Heart Hospital Bakersfield CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Scott","family":"Lim","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of Virginia Charlottesville VA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3367-0302","authenticated-orcid":false,"given":"Suzanne V.","family":"Arnold","sequence":"additional","affiliation":[{"name":"University of Missouri\u2010Kansas City School of Medicine Kansas City MO"},{"name":"Saint Luke\u2019s Mid America Heart Institute Kansas City MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8440-9337","authenticated-orcid":false,"given":"Yanru","family":"Li","sequence":"additional","affiliation":[{"name":"Clinical Trials Center Cardiovascular Research Foundation New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9207-3634","authenticated-orcid":false,"given":"JoAnn","family":"Lindenfeld","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure and Cardiac Transplantation Section Vanderbilt Heart and Vascular Institute Nashville TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4805-1037","authenticated-orcid":false,"given":"William T.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine The Ohio State University Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3148-9158","authenticated-orcid":false,"given":"Michael J.","family":"Mack","sequence":"additional","affiliation":[{"name":"Baylor Scott & White Health Plano TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3416-8210","authenticated-orcid":false,"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7133.2010.00140.x"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hfc.2013.10.006"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.09.015"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.03.057"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.109.866558"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002693"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jjcc.2019.01.011"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2018.07.021"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1806640"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.09.017"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00335-3"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.122.028444","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:57:50Z","timestamp":1715605070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.122.028444"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,2,21]]}},"alternative-id":["10.1161\/JAHA.122.028444"],"URL":"https:\/\/doi.org\/10.1161\/jaha.122.028444","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]},"assertion":[{"value":"2022-10-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e028444"}}