Prediction of mortality and heart failure hospitalisations in patients undergoing M-TEER: external validation of the COAPT risk score

DOI: 10.4244/EIJ-D-22-00992

Marianna Adamo
Marianna Adamo1, MD; Antonio Popolo Rubbio2, MD; Gregorio Zaccone1, MD; Michele Pighi3, MD; Mauro Massussi1, MD; Daniela Tomasoni1, MD; Edoardo Pancaldi1, MD; Luca Testa2, MD, PhD; Maurizio B. Tusa2, MD; Federico De Marco4, MD; Cristina Giannini5, MD, PhD; Carmelo Grasso6, MD; Francesco De Felice7, MD; Paolo Denti8, MD; Cosmo Godino9, MD; Annalisa Mongiardo10, MD; Gabriele Crimi11, MD; Emmanuel Villa12, MD; Ida Monteforte13, MD; Rodolfo Citro14, MD; Arturo Giordano15, MD; Antonio L. Bertorelli4, MD; Anna Sonia Petronio5, MD; Giuliano Chizzola1, MD; Giuseppe Tarantini16, MD; Corrado Tamburino6, MD; Francesco Bedogni2, MD; Marco Metra1, MD
1. Cardiology and Cardiac catheterization laboratory, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 2. Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; 3. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy; 4. Centro Cardiologico Monzino, IRCCS, Milan, Italy; 5. Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; 6. Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele, University of Catania, Catania, Italy; 7. Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy; 8. Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy; 9. Cardio-Thoracic-Vascular Department, San Raffaele University Hospital, Milan, Italy; 10. Division of Cardiology, University Magna Graecia, Catanzaro, Italy; 11. Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV) IRCCS, Ospedale Policlinico San Martino Genoa, Genova, Italy; 12. Cardiac Surgery Unit and Transcatheter Valve Therapy Group, Poliambulanza Foundation Hospital, Brescia, Italy; 13. AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy; 14. University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy; 15. Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy; 16. Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy

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. 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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chronic heart failuremitral regurgitationmitral valve repair
Interventions for heart failureMitral valve replacement and repairChronic heart failure
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