Eligibility coapt trial in daily practice: a real world experience

Abstract Background The 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 patient. The exact proportion of patients fulfilling COAPT selection criteria in the real–world is unknown. Objectives To assess the of COAPT in real–world . Methods We 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 and received. COAPT eligibility was retrospectively assessed by a cardiac surgeon and a cardiologist Results Among 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%). The 4–year survival between non–COAPT (MC–NC) patients vs Medical Therapy (MC–NC) group was 91,5% (CI: [0.864, 0.96] vs 71,8 % (CI = [0.509, 0.926]) respectively, p=0.027,Figure 1. Concerning the 4–year recurrent MR>=3+ in MitraClip patients was 17,2% (CI: [0.101, 0.238]), while in Medical therapy group was 40% (CI = [0.248, 0.522]), p 0.0019, Figure 2. Conclusions Only a minority (14%) of real–world patients with FMR referred to a tertiary hospital fulfilled the COAPT selection criteria. Patients treated with MitraClip beyond the restrictive COAPT.