The COAPT Risk Score showed limited predictive ability for the composite outcome of all-cause mortality or heart failure hospitalization (AUC 0.598) in a real-world SMR cohort undergoing TEER.
Cohort (n=450)
Yes
Does the COAPT Risk Score accurately predict all-cause mortality or HF hospitalization in real-world patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair?
The COAPT Risk Score has limited utility for predicting the composite of mortality and heart failure hospitalization in real-world patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation, though it moderately predicts mortality alone.
Effect estimate: AUC 0.598
p-value: p=0.0236
Abstract Background Secondary mitral regurgitation (SMR) is the most common form of mitral regurgitation and is associated with poor prognosis, particularly in heart failure patients. Transcatheter edge-to-edge repair (TEER) is a therapeutic option for inoperable patients, yet optimal selection remains critical. The COAPT Risk Score predicts all-cause mortality and HF hospitalization after TEER, but its real-world validity is uncertain. Aims This study evaluates the predictive performance of the COAPT Risk Score in a real-world SMR cohort undergoing TEER using a multicenter registry. Methods Patients with SMR treated with MitraClip were included. The COAPT Risk Score was calculated from clinical and echocardiographic variables, stratifying patients into tertiles. The primary outcome was all-cause mortality or HF hospitalization at two years. Kaplan-Meier, Cox regression, and ROC analyses assessed predictive performance. Results Among 450 patients, 226 had complete data. Median follow-up was 602 days (IQR: 393–730). Event rates increased across tertiles (28.8% to 52.2%, p=0.0236). The COAPT Risk Score showed limited predictive ability for the composite outcome (AUC 0.598) and HF hospitalization (AUC 0.555), but better for mortality (AUC 0.639). Conclusion The COAPT Risk Score moderately predicts mortality but has limited utility for broader risk stratification in real-world settings.
Martino et al. (2025) conducted a cohort in Secondary mitral regurgitation (SMR) (n=450). COAPT Risk Score was evaluated on All-cause mortality or HF hospitalization at two years (AUC 0.598, p=0.0236). The COAPT Risk Score showed limited predictive ability for the composite outcome of all-cause mortality or heart failure hospitalization (AUC 0.598) in a real-world SMR cohort undergoing TEER.