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

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BACKGROUND: Coronary angiography remains standard for assessing lesions in valve surgery patients with concomitant coronary artery disease. OBJECTIVES: This study assessed the prognostic value of functional evaluation using quantitative flow ratio in these patients. METHODS: Consecutive patients undergoing valve surgery (January 2016-December 2021) with ≥1 vessel stenosis (50%-90%) were included. Patients were categorized into complete revascularization (CR) or incomplete revascularization (ICR) groups by functional and traditional anatomical criteria. The primary endpoint was major adverse cardiovascular events ([MACE]; all-cause death, myocardial infarction, unplanned revascularization, stroke). RESULTS: A total of 750 patients were enrolled in the study, and 244 (32.5%) underwent combined bypass surgery. In the entire cohort, 547 patients (72.9%) met anatomical CR criteria, and 560 patients (74.7%) met functional CR criteria. After median follow-up of 3.0 years (Q1-Q3: 2.0-5.0 years). MACE were significantly increased in the functional ICR group than that in the functional CR group (20.5% [95% CI: 15.4%-26.8%] vs 10.9% [95% CI: 8.6%-13.7%]; HR: 1.98; 95% CI: 1.26-3.11; P<0.001). Meanwhile, no significant differences in MACE rates between the anatomical ICR group and the CR group (16.3% [95% CI: 11.8%-21.9%] vs 12.2% [95% CI: 9.8%-15.3%]; HR: 1.35; 95% CI: 0.87-2.10; P = 0.153). In multivariable regression analysis, functional ICR was an independent predictor for MACE (adjusted HR: 1.63; 95% CI: 1.01-2.64; P = 0.038) compared with functional CR. CONCLUSIONS: Functional ICR in patients undergoing valve surgery with coronary artery disease is associated with increased MACE. These findings support using functional assessment to guide revascularization decisions.

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