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.
Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
EuroIntervention. 2023 Apr 24;18(17):1408-1417. doi: 10.4244/EIJ-D-22-00992.
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.
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).
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.
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.
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.
最近从 MitraClip 经皮治疗心力衰竭伴功能性二尖瓣反流患者的心血管结局评估（COAPT）试验中得出了一个风险评分。然而，该评分的外部验证仍然缺乏。
我们旨在通过二尖瓣经导管缘对缘修复（M-TEER）治疗继发性二尖瓣反流（SMR）的大型多中心人群中验证 COAPT 风险评分。
根据 COAPT 评分四分位数对意大利介入心脏病学会（GIse）经导管治疗二尖瓣反流注册研究（GIOTTO）人群进行分层。在总人群中和具有或不具有 COAPT 样特征的患者中，评估 COAPT 评分对 2 年全因死亡或心力衰竭（HF）住院的预测性能。
在 GIOTTO 注册研究的 1659 例患者中，934 例患者有 SMR 且可获得 COAPT 风险评分计算的完整数据。在总人群中，COAPT 评分四分位数逐渐增加，2 年全因死亡或 HF 住院的发生率也随之增加（26.4% vs 44.5% vs 49.4% vs 59.7%；对数秩检验 p<0.001）和 COAPT 样患者（24.7% vs 32.4% vs 52.3% vs. 53.4%；对数秩检验 p=0.004），但在非 COAPT 样患者中则不然。COAPT 风险评分在总人群中的区分度较差，校准度较好；在 COAPT 样患者中，区分度和校准度均为中度；而非 COAPT 样患者的区分度和校准度均非常差。
COAPT 风险评分在接受 M-TEER 的真实世界患者的预后分层中表现不佳。然而，在应用于 COAPT 样特征的患者后，观察到中等程度的区分度和较好的校准度。
