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