Acute Mitral RegurgitationEMCAMINCT06282042
Early Transcatheter Mitral Valve Repair After Myocardial Infarction
A study testing Early transcatheter edge-to-edge mitral valve repair (TEER)., MitraClip and Optimal medical treatment in people with Acute Mitral Regurgitation, run by Fundación para la Investigación Biosanitaria del Principado de Asturias at 32 sites in 4 countries.
Trial summary
To explore the impact of early transcatheter edge-to-edge repair of acute functional mitral regurgitation after myocardial infarction on the combined incidence of death and heart-failure associated hospitalisations at one-year follow-up, and quality of life and LV remodelling at two-year follow-up. Read more about this study
- Who is it for?
- Ages 18 to 99 years
- Conditions the study is for
- Acute Mitral Regurgitation
- What is being tested?
- Early transcatheter edge-to-edge mitral valve repair (TEER)., MitraClip and Optimal medical treatment
- Type of treatment
- Medical device, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 250 participants
- Where
- 32 sitesin 4 countries
- Study dates
- 24 Dec 2024to 16 Jun 2028
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 99 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients with symptomatic moderate to severe or severe MR after acute MI
- Age > 18 years
- Based on the following classification recently published in "Transcatheter Mitral Edge-to-Edge Repair for Treatment of Acute Mitral Regurgitation" by M. Shuvy et al. (Can J Cardiol. 2023) patients will be included if categorized in Type 2, 3 or 4:
Who cannot join
- Primary MR (e.g. papillary muscle rupture)
- EF ≤ 25%
- Accepted for CABG
- Presence of cardiogenic shock (AMR type 1)
Trial locations and contacts
32 sites in 4 countries. Contact the study team or a site near you to ask about taking part.
32 sites in 4 countries
Spain15 sites, 15 recruiting
- Not yet recruiting
Hospital General Universitario Dr. Balmis
Alicante, Alicante, 03010
José Valencia Martín, MD, PhD
José Valencia Martín, MD, PhD
- Not yet recruiting
Hospital de la Santa Creu i Sant Pau
Barcelona, Barcelona, 08025
Dabit Arzamendi, MD, PhD
Dabit Arzamendi, MD, PhD
- Not yet recruiting
Hospital Universitario Vall d'Hebrón
Barcelona, Barcelona, 08035
Bruno García del Blanco, MD, PhD
Dr. Bruno García del Blanco, MD, PhD
- Not yet recruiting
Hospital Clínic Barcelona
Barcelona, Barcelona, 08036
Xavier Freixa Rofastes, MD, PhD
Dr. Xavier Freixa Rofastes, MD, PhD
- Not yet recruiting
Hospital Universitario Reina Sofía
Córdoba, Córdoba, 14004
Manuel Pan Álvarez, MD, PhD
Dr. Manuel Pan Álvarez, MD, PhD
- Not yet recruiting
Hospital Universitario de Bellvitge
L'Hospitalet de Llobregat, Barcelona, 08907
Gerard Roura, +34932607500, groura@bellvitgehospital.cat
Gerard Roura
- Not yet recruiting
Hospital Universitario Doctor Negrin
Las Palmas de Gran Canaria, Las Palmas, 35010
Pedro Martín, MD, PhD
Dr. Pedro Martín, MD, PhD
- Not yet recruiting
Hospital Universitario Ramón y Cajal
Madrid, Madrid, 28034
Ángel Sánchez-Recalde, MD, PhD
Dr. Ángel Sánchez-Recalde, MD, PhD
- Not yet recruiting
Hospital Clínico Universitario San Carlos
Madrid, Madrid, 28040
Luis Nombela, MD, PhD
Dr. Luis Nombela, MD, PhD
- Not yet recruiting
Hospital Universitario Puerta de Hierro
Madrid, Madrid, 28222
María del Trigo, MD, PhD
Dra. María del Trigo, MD, PhD
- Not yet recruiting
Hospital Universitario Virgen de la Victoria
Málaga, Málaga, 29010
Juan H. Alonso Briales, MD, PhD
Dr. Juan H. Alonso Briales, MD, PhD
- Recruiting
Hospital Universitario Central de Asturias (HUCA)
Oviedo, Principality of Asturias, 33011
Isaac Pascual Calleja, MD, PhD, +34985101738, ipascua@live.com
Isaac Pascual Calleja
- Not yet recruiting
Hospital Universitario Marqués de Valdecilla
Santander, Cantabria, 39008
Jose María de la Torre, MD, PhD
Dr. Jose María de la Torre, MD, PhD
- Not yet recruiting
Hospital Clínico Universitario de Valladolid
Valladolid, Valladolid, 47003
Ignacio Amat-Santos, MD, PhD
Dr. Ignacio Amat-Santos, MD, PhD
- Not yet recruiting
Hospital Álvaro Cunqueiro
Vigo, Pontevedra, 36312
Rodrigo Estévez-Loureiro, MD, PhD
Dr. Rodrigo Estévez-Loureiro, MD, PhD
Netherlands8 sites, 8 recruiting
- Not yet recruiting
Amsterdam University Medical Center
Amsterdam, Amsterdam, 1081 HV
R. Delewi
Dr. R. Delewi
- Not yet recruiting
Amphia Hospital
Breda, Breda, 4818 CK
B. van der Branden
Dr. B. van der Branden
- Not yet recruiting
Catharina Ziekenhuis Hospital
Eindhoven, Eindhoven, 5623 EJ
P. Tonino
Dr. P. Tonino
- Not yet recruiting
Leiden University Medical Center
Leiden, Leiden, 2333 ZA
F. van der Kley
Dr. F. van der Kley
- Not yet recruiting
Maastricht University Medical Center
Maastricht, Maastricht, 6229 HX
P.A. Vriesendorp
Dr. P.A. Vriesendorp
- Not yet recruiting
St. Antonius Hospital
Nieuwegein, Nieuwegein, 3435 CM
L. Timmers
Dr. L. Timmers
- Not yet recruiting
Erasmus University Medical Center
Rotterdam, Rotterdam, 3015 GD
N. van Mieghem
Dr. N. van Mieghem
- Not yet recruiting
Isala Hospital
Zwolle, Zwolle, 8025 AB
R. Hermanides
Dr. R. Hermanides
Italy5 sites, 5 recruiting
- Not yet recruiting
Civil Hospital of Brescia
Brescia, Brescia, 25123
Marianna Adamo
Dra. Marianna Adamo
- Not yet recruiting
Ospedale Policlinico San Martino
Genova, Genova, 16132
Italo Porto, +390105551, italo.porto@unige.it
Italo Porto
- Not yet recruiting
San Raffaele Hospital
Milan, Milano, 20132
Cosmo Godino
Dr. Cosmo Godino
- Not yet recruiting
Centro Cardiológico Monzino
Milan, Milan, 20138
Federico de Marco, +3902580021, federico.demarco@gmail.com
Federico de Marco
- Not yet recruiting
Policlínico San Donato
San Donato Milanese, San Donato Milanese, 20097
Francesco Bedogni
Dr. Francesco Bedogni
Israel4 sites, 4 recruiting
- Not yet recruiting
Emek Medical Center
Afula, Afula, 1834111
Limor Bushari, +97246495000, limor_il@clalit.org.il
Limor Bushari
- Recruiting
Shaare Zedek Medical Center
Jerusalem, Jerusalen, 9103102
Mony Shuvy
Dr. Mony Shuvy
- Not yet recruiting
Rabin Medical Center
Petah Tikva, Petah Tikva, 4941492
Leor Perl
Dr. Leor Perl
- Not yet recruiting
Sheba Medical Center
Ramat Gan, Ramat Gan
Paul Fefer
Dr. Paul Fefer
About this study
To explore the impact of early transcatheter edge-to-edge repair of acute functional mitral regurgitation after myocardial infarction on the combined incidence of death and heart-failure associated hospitalisations at one-year follow-up, and quality of life and LV remodelling at two-year follow-up.
Read the detailed description
Prospective, multicentre, randomised, open-label, comparative effectiveness clinical trial for the treatment of clinically significant functional mitral regurgitation within 60 days after acute myocardial infarction, who are treated per standard of care and who have been determined by the site's local heart team as inappropriate or too high risk for mitral valve surgery.
Eligible subjects will be randomized in a 1:1 ratio to the MitraClip device (intervention group) or to no MitraClip device (Control group).
- Conditions
- Acute Mitral Regurgitation
- Being tested
- Early transcatheter edge-to-edge mitral valve repair (TEER)., MitraClip, Optimal medical treatment
- Keywords
- MitraClip
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Early transcatheter edge-to-edge mitral valve repair (TEER).Procedure or surgery
TEER will be planned and performed as soon as possible, but within 60 days after index myocardial infarction, and within 30 days of randomisation using the MitraClip device.
MitraClipDevice
MitraClip
Optimal medical treatmentOther
Optimal medical treatment
| Study group | Role | What they receive |
|---|---|---|
| TEER + OMT | Experimental | Early transcatheter edge-to-edge mitral valve repair (TEER) plus optimal medical treatment Receives: Procedure: Early transcatheter edge-to-edge mitral valve repair (TEER).; Device: MitraClip; Other: Optimal medical treatment |
| OMT | Other | Optimal medical treatment Receives: Other: Optimal medical treatment |
What is being measured
The primary outcome is the main question the study is designed to answer.
All-cause death or Cumulative Heart Failure hospitalizations
Composite of
- All-cause death
- Cumulative Heart Failure hospitalizations
Measured: 12 months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted28 Feb 2024
- Study start24 Dec 2024
- Primary completion16 Jun 2027 (estimated)
- Study completion16 Jun 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Acute Mitral RegurgitationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Prospective, multicentre, randomised, open-label, comparative effectiveness clinical trial for the treatment of clinically significant functional mitral regurgitation within 60 days after acute myocardial infarction, who are treated per standard of care and who have been determined by the site's local heart team as inappropriate or too high risk for mitral valve surgery.
- Masking
- None (open label)
- Enrolment
- 250 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Fundación para la Investigación Biosanitaria del Principado de Asturias
- Sponsor type
- University, hospital or other
- Collaborators
- Meditrial Europe Ltd.
- Responsible party
- Principal investigator, Isaac Pascual Calleja, Fundación para la Investigación Biosanitaria del Principado de Asturias
- Investigators
- Isaac Pascual, MD, PhD, Principal investigator, Hospital Universitario Central de Asturias
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06282042
- Sponsor's protocol ID
- EMCAMI
- Acronym
- EMCAMI
- Status last verified
- Dec 2024
- First submitted
- 21 Feb 2024
- Last updated
- 20 Oct 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- Yes
- Individual data sharing
- No
Publications
Pocock SJ, Ariti CA, Collier TJ, Wang D. The win ratio: a new approach to the analysis of composite endpoints in clinical trials based on clinical priorities. Eur Heart J. 2012 Jan;33(2):176-82. doi: 10.1093/eurheartj/ehr352. Epub 2011 Sep 6.
PubMed 21900289Finkelstein DM, Schoenfeld DA. Combining mortality and longitudinal measures in clinical trials. Stat Med. 1999 Jun 15;18(11):1341-54. doi: 10.1002/(sici)1097-0258(19990615)18:113.0.co;2-7.
PubMed 10399200Shuvy M, Maisano F, Strauss BH. Transcatheter Mitral Edge-to-Edge Repair for Treatment of Acute Mitral Regurgitation. Can J Cardiol. 2023 Oct;39(10):1382-1389. doi: 10.1016/j.cjca.2023.05.009. Epub 2023 May 18.
PubMed 37209883Shuvy M, von Bardeleben RS, Grasso C, Raake P, Lurz P, Zamorano JL, Asch F, Kar S, Maisano F; EXPAND Investigators. Safety and efficacy of MitraClip in acutely ill (NYHA Class IV) patients with mitral regurgitation: Results from the global EXPAND study. ESC Heart Fail. 2023 Apr;10(2):1122-1132. doi: 10.1002/ehf2.14273. Epub 2023 Jan 4.
PubMed 36599332Haberman D, Estevez-Loureiro R, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Nombela-Franco L, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Pascual I, Praz F, Sudarsky D, Kerner A, Ninios V, Gennari M, Beeri R, Perl L, Wasserstrum Y, Danenberg H, Poles L, George J, Caneiro-Queija B, Scianna S, Moaraf I, Schiavi D, Scardino C, Corpataux N, Echarte-Morales J, Chrissoheris M, Fernandez-Peregrina E, Di Pasquale M, Regueiro A, Vergara-Uzcategui C, Iniguez-Romo A, Fernandez-Vazquez F, Dvir D, Maisano F, Taramasso M, Shuvy M. Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction. Eur Heart J. 2022 Feb 12;43(7):641-650. doi: 10.1093/eurheartj/ehab496.
PubMed 34463727Jung RG, Simard T, Kovach C, Flint K, Don C, Di Santo P, Adamo M, Branca L, Valentini F, Benito-Gonzalez T, Fernandez-Vazquez F, Estevez-Loureiro R, Berardini A, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Manovel A, Cardenal-Piris R, Diaz Fernandez J, Shuvy M, Haberman D, Sala A, Alkhouli MA, Marini C, Bargagna M, Schiavi D, Denti P, Markovic S, Buzzatti N, Chan V, Hynes M, Mesana T, Labinaz M, Pappalardo F, Taramasso M, Hibbert B. Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. JACC Cardiovasc Interv. 2021 Jan 11;14(1):1-11. doi: 10.1016/j.jcin.2020.08.037. Epub 2020 Oct 14.
PubMed 33069653
Study at a glance
From the registry record, last updated by the sponsor on 20 Oct 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Early Transcatheter Mitral Valve Repair After Myocardial Infarction
- ClinicalTrials.gov ID
- NCT06282042
- Acronym / sponsor ID
- EMCAMI / EMCAMI
- Conditions
- Acute Mitral Regurgitation
- Keywords
- MitraClip
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 250 participants (estimated)
- Lead sponsor
- Fundación para la Investigación Biosanitaria del Principado de AsturiasUniversity, hospital or other
- Collaborators
- Meditrial Europe Ltd.
- Study start
- 24 Dec 2024 (actual)
- Primary completion
- 16 Jun 2027 (estimated)
- Study completion
- 16 Jun 2028 (estimated)
- First posted
- 28 Feb 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To explore the impact of early transcatheter edge-to-edge repair of acute functional mitral regurgitation after myocardial infarction on the combined incidence of death and heart-failure associated hospitalisations at one-year follow-up, and quality of life and LV remodelling at two-year follow-up.
Detailed description
Prospective, multicentre, randomised, open-label, comparative effectiveness clinical trial for the treatment of clinically significant functional mitral regurgitation within 60 days after acute myocardial infarction, who are treated per standard of care and who have been determined by the site's local heart team as inappropriate or too high risk for mitral valve surgery.
Eligible subjects will be randomized in a 1:1 ratio to the MitraClip device (intervention group) or to no MitraClip device (Control group).
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Prospective, multicentre, randomised, open-label, comparative effectiveness clinical trial for the treatment of clinically significant functional mitral regurgitation within 60 days after acute myocardial infarction, who are treated per standard of care and who have been determined by the site's local heart team as inappropriate or too high risk for mitral valve surgery.
| Arm | Type | Receives |
|---|---|---|
| TEER + OMT | Experimental | Procedure: Early transcatheter edge-to-edge mitral valve repair (TEER)., Device: MitraClip, Other: Optimal medical treatmentEarly transcatheter edge-to-edge mitral valve repair (TEER) plus optimal medical treatment |
| OMT | Other | Other: Optimal medical treatmentOptimal medical treatment |
Who may qualify
- Ages
- 18 to 99 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- Patients with symptomatic moderate to severe or severe MR after acute MI
- Age > 18 years
- Based on the following classification recently published in "Transcatheter Mitral Edge-to-Edge Repair for Treatment of Acute Mitral Regurgitation" by M. Shuvy et al. (Can J Cardiol. 2023) patients will be included if categorized in Type 2, 3 or 4:
Key exclusion criteria (4 listed)
- Primary MR (e.g. papillary muscle rupture)
- EF ≤ 25%
- Accepted for CABG
- Presence of cardiogenic shock (AMR type 1)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Early transcatheter edge-to-edge mitral valve repair (TEER).TEER will be planned and performed as soon as possible, but within 60 days after index myocardial infarction, and within 30 days of randomisation using the MitraClip device. | Procedure or surgery | TEER + OMT |
| MitraClipMitraClip | Device | TEER + OMT |
| Optimal medical treatmentOptimal medical treatment | Other | OMT, TEER + OMT |
Primary outcome
All-cause death or Cumulative Heart Failure hospitalizations
Time frame: 12 months
Composite of 1. All-cause death 2. Cumulative Heart Failure hospitalizations
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Oct 2025.
- Background: PubMed 21900289Pocock SJ, Ariti CA, Collier TJ, Wang D. The win ratio: a new approach to the analysis of composite endpoints in clinical trials based on clinical priorities. Eur Heart J. 2012 Jan;33(2):176-82. doi: 10.1093/eurheartj/ehr352. Epub 2011 Sep 6.
- Background: PubMed 10399200Finkelstein DM, Schoenfeld DA. Combining mortality and longitudinal measures in clinical trials. Stat Med. 1999 Jun 15;18(11):1341-54. doi: 10.1002/(sici)1097-0258(19990615)18:113.0.co;2-7.
- Background: PubMed 37209883Shuvy M, Maisano F, Strauss BH. Transcatheter Mitral Edge-to-Edge Repair for Treatment of Acute Mitral Regurgitation. Can J Cardiol. 2023 Oct;39(10):1382-1389. doi: 10.1016/j.cjca.2023.05.009. Epub 2023 May 18.
- Background: PubMed 36599332Shuvy M, von Bardeleben RS, Grasso C, Raake P, Lurz P, Zamorano JL, Asch F, Kar S, Maisano F; EXPAND Investigators. Safety and efficacy of MitraClip in acutely ill (NYHA Class IV) patients with mitral regurgitation: Results from the global EXPAND study. ESC Heart Fail. 2023 Apr;10(2):1122-1132. doi: 10.1002/ehf2.14273. Epub 2023 Jan 4.
- Background: PubMed 34463727Haberman D, Estevez-Loureiro R, Benito-Gonzalez T, Denti P, Arzamendi D, Adamo M, Freixa X, Nombela-Franco L, Villablanca P, Krivoshei L, Fam N, Spargias K, Czarnecki A, Pascual I, Praz F, Sudarsky D, Kerner A, Ninios V, Gennari M, Beeri R, Perl L, Wasserstrum Y, Danenberg H, Poles L, George J, Caneiro-Queija B, Scianna S, Moaraf I, Schiavi D, Scardino C, Corpataux N, Echarte-Morales J, Chrissoheris M, Fernandez-Peregrina E, Di Pasquale M, Regueiro A, Vergara-Uzcategui C, Iniguez-Romo A, Fernandez-Vazquez F, Dvir D, Maisano F, Taramasso M, Shuvy M. Conservative, surgical, and percutaneous treatment for mitral regurgitation shortly after acute myocardial infarction. Eur Heart J. 2022 Feb 12;43(7):641-650. doi: 10.1093/eurheartj/ehab496.
- Background: PubMed 33069653Jung RG, Simard T, Kovach C, Flint K, Don C, Di Santo P, Adamo M, Branca L, Valentini F, Benito-Gonzalez T, Fernandez-Vazquez F, Estevez-Loureiro R, Berardini A, Conti N, Rapezzi C, Biagini E, Parlow S, Shorr R, Levi A, Manovel A, Cardenal-Piris R, Diaz Fernandez J, Shuvy M, Haberman D, Sala A, Alkhouli MA, Marini C, Bargagna M, Schiavi D, Denti P, Markovic S, Buzzatti N, Chan V, Hynes M, Mesana T, Labinaz M, Pappalardo F, Taramasso M, Hibbert B. Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis. JACC Cardiovasc Interv. 2021 Jan 11;14(1):1-11. doi: 10.1016/j.jcin.2020.08.037. Epub 2020 Oct 14.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Isaac Pascual, MD, PhD principal investigator
Hospital Universitario Central de Asturias
32 sites in 4 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Early transcatheter edge-to-edge mitral valve repair (TEER)., MitraClip and Optimal medical treatment in people with Acute Mitral Regurgitation, run by Fundación para la Investigación Biosanitaria del Principado de Asturias at 32 sites in 4 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 20 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 32 sites in Spain, Netherlands, Italy, Israel. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Isaac Pascual MD, PhD (985101738, ipascua@live.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
All-cause death or Cumulative Heart Failure hospitalizations (time frame: 12 months). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06282042, which also lists 6 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Oct 2025.