Eligibility to COAPT trial in the daily practice: A real‐world experience

Abstract

AbstractBackgroundThe COAPT Trial was the first ever to demonstrate a survival benefit in treating functional mitral regurgitation (FMR). That was achieved through transcatheter mitral repair in selected patients. The exact proportion of patients fulfilling COAPT selection criteria in the real‐world is unknown.AimsTo assess the applicability of COAPT criteria in real world and its impact on patients’ survival.MethodsWe assessed the clinical data and follow‐up results of all consecutive patients admitted for FMR at our Department between January 2016 and May 2021 according to COAPT eligibility. COAPT eligibility was retrospectively assessed by a cardiac surgeon and a cardiologist.ResultsAmong 394 patients, 56 (14%) were COAPT eligible. The most frequent reasons for exclusion were MR ≤ 2 (22%), LVEF < 20% or >50% (19%), and non‐optimized GDMT (21.3%).Among Non‐COAPT patients, weighted 4‐year survival was higher in patients who received MitraClip compared to those who were left in optimized medical therapy (91.5% confidence interval [CI: 0.864, 0.96] vs. 71.8% [CI: 0.509, 0.926], respectively, p = 0.027).ConclusionsOnly a minority (14%) of real‐world patients with FMR referred to a tertiary hospital fulfilled the COAPT selection criteria. Among Non‐COAPT patients, weighted 4‐year survival was higher in patients who received MitraClip compared to those who were left in optimized medical therapy (91.5% [0.864, 0.96] vs. 71.8% [0.509, 0.926], respectively, p = 0.027).