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Prognostic Value of Functional Incomplete Revascularization in Patients Undergoing Valve Surgery With Coronary Artery

Fang Zhang1, Wei Gao2, Wenshuo Wang3

  • 1School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China.

JACC. Asia
|August 29, 2025
PubMed

Insights

Functional assessment using quantitative flow ratio in valve surgery patients with coronary artery disease significantly predicts major adverse cardiovascular events (MACE). Functional incomplete revascularization, not anatomical, is linked to higher MACE, supporting its use in guiding treatment.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary angiography is standard for assessing coronary artery disease in valve surgery patients.
  • Evaluating coronary lesions is crucial for optimal patient outcomes.

Purpose of the Study:

  • To assess the prognostic value of functional evaluation using quantitative flow ratio (QFR).
  • To compare functional versus anatomical criteria for revascularization in patients undergoing valve surgery.

Main Methods:

  • A cohort of 750 patients undergoing valve surgery with significant coronary stenosis (50%-90%) was analyzed.
  • Patients were classified into complete revascularization (CR) or incomplete revascularization (ICR) groups based on functional (QFR) and anatomical criteria.
  • Major adverse cardiovascular events (MACE) were tracked over a median follow-up of 3.0 years.

Main Results:

  • Functional incomplete revascularization (ICR) was associated with significantly increased MACE (20.5%) compared to functional complete revascularization (CR) (10.9%) (HR: 1.98; P<0.001).
  • No significant difference in MACE rates was observed between anatomical ICR and CR groups (16.3% vs 12.2%; P = 0.153).
  • Functional ICR emerged as an independent predictor of MACE (adjusted HR: 1.63; P = 0.038).

Conclusions:

  • Functional incomplete revascularization in patients with coronary artery disease undergoing valve surgery is linked to higher MACE.
  • These findings highlight the importance of functional assessment (QFR) in guiding revascularization decisions for improved patient outcomes.
Abstract

Keywords:
coronary artery bypass graftfunctional incomplete revascularizationphysiological assessmentquantitative flow ratiovalve surgery

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