Key result
COAPT risk score shows poor discrimination for 2-year death or HF hospitalization in real-world M-TEER patients.
Why the study?
A risk score was recently derived from the COAPT trial, but external validation of this score was still lacking.
Does the COAPT risk score accurately predict 2-year all-cause death or HF hospitalisation in real-world patients undergoing M-TEER for secondary mitral regurgitation?
Observational (n=934)
Yes
Does the COAPT risk score accurately predict 2-year all-cause death or HF hospitalisation in real-world patients undergoing M-TEER for secondary mitral regurgitation?
p-value: p=<0.001
The COAPT risk score has poor prognostic performance in unselected real-world patients undergoing M-TEER for secondary mitral regurgitation, but performs moderately well in patients matching the COAPT trial profile.
COAPT risk score should not yet guide M-TEER decisions in unselected patients; leaves open validation and refinement in COAPT-like subgroups.
BACKGROUND: A risk score was recently derived from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial. However, external validation of this score is still lacking. AIMS: We aimed to validate the COAPT risk score in a large multicentre population undergoing mitral transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR). METHODS: The Italian Society of Interventional Cardiology (GIse) Registry of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO) population was stratified according to COAPT score quartiles. The performance of the COAPT score for 2-year all-cause death or heart failure (HF) hospitalisation was evaluated in the overall population and in patients with or without a COAPT-like profile. RESULTS: Among the 1,659 patients included in the GIOTTO registry, 934 had SMR and complete data for a COAPT risk score calculation. The incidence of 2-year all-cause death or HF hospitalisation progressively increased through the COAPT score quartiles in the overall population (26.4% vs 44.5% vs 49.4% vs 59.7%; log-rank p<0.001) and COAPT-like patients (24.7% vs 32.4% vs 52.3% vs. 53.4%; log-rank p=0.004), but not in those with a non-COAPT-like profile. The COAPT risk score had poor discrimination and good calibration in the overall population, moderate discrimination and good calibration in COAPT-like patients and very poor discrimination and poor calibration in non-COAPT-like patients. CONCLUSIONS: The COAPT risk score has a poor performance in the prognostic stratification of real-world patients undergoing M-TEER. However, after application to patients with a COAPT-like profile, moderate discrimination and good calibration were observed.
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Adamo et al. (2023) conducted an observational in Secondary mitral regurgitation (n=934). COAPT risk score was evaluated on 2-year all-cause death or heart failure hospitalisation (p=<0.001). The COAPT risk score showed poor discrimination for 2-year death or HF hospitalization in real-world M-TEER patients, despite event rates increasing across quartiles (26.4% to 59.7%; p<0.001).
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