Shah et al reported the COAPT risk score for evaluating the prognosis for a patient with severe functional mitral regurgitation (FMR). The authors are from multiple institutions in the United States participating in the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation.
Patient selection: severe mitral regurgitation
Outcome: death or hospitalization for heart failure within 2 years
Parameters:
(1) eGFR in mL per min
(2) COPD
(3) history of atrial fibrillation or flutter
(4) NYHA functional status
(5) left ventricular ejection fraction (LVEF) in percent
(6) LVESD in cm
(7) grade of tricuspid regurgitation from 0 to 4+
(8) RVSP in mm Hg
(9) MitraClip treatment
Parameter
Finding
Points
eGFR
> 60 mL/min
0
30 to 60 mL/min
1
< 30 mL/min
3
COPD
no
0
yes
1
atrial fibrillation or flutter
no
0
yes
1
NYHA class
I or II
0
III or IV
1
LVEF
> 35%
0
25 to 25%
1
< 25%
2
LVESD
<= 5.5 cm
0
> 5.5 cm
2
tricuspid regurgitation
0 or 1+
0
>= 2+
2
RVSP
<= 45 mm Hg
0
> 45 mm Hg
3
Mitraclip treatment
no
0
yes
-3
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -3
• maximum score: 15
Total Score
Quartile
2-Year Death or Heart Failure Hospitalization
-3 to 4
1
48%
5 or 6
2
63%
7 or 8
3
83%
9 to 15
4
87%
Performance:
• The area under the ROC curve is 0.74.
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