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

JACC. Asia Pub Date : 2025-10-01 DOI:10.1016/j.jacasi.2025.07.007

Fang Zhang BSc , Wei Gao MD, PhD , Wenshuo Wang MD, PhD , Runda Wu MD, PhD , Yan Xia MD, PhD , Jingpu Wang MD, PhD , Qiyu Zhang MD, PhD , Jinying Zhou MD, PhD , Rende Xu MD, PhD , Zhangwei Chen MD, PhD , Yongxin Sun MD, PhD , Shengxian Tu BSc , Chunsheng Wang MD, PhD , Chenguang Li MD, PhD , Junbo Ge MD, PhD

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引用次数: 0

Abstract

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.

查看原文本刊更多论文

冠状动脉疾病瓣膜手术患者功能性不完全血运重建术的预后价值。

背景：冠状动脉造影仍然是评估瓣膜手术合并冠状动脉疾病患者病变的标准。目的：本研究评估定量血流比功能评价在这些患者中的预后价值。方法：纳入2016年1月- 2021年12月连续行瓣膜手术且血管狭窄≥1条（50%-90%）的患者。根据功能和传统解剖标准，将患者分为完全血运重建术（CR）组和不完全血运重建术（ICR）组。主要终点是主要不良心血管事件（MACE）；全因死亡、心肌梗死、计划外血运重建术、卒中)。结果：共有750例患者入组研究，其中244例（32.5%）接受了联合搭桥手术。在整个队列中，547例患者（72.9%）符合解剖学CR标准，560例患者（74.7%）符合功能性CR标准。中位随访3.0年（Q1-Q3: 2.0-5.0年）。功能性ICR组的MACE明显高于功能性CR组(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；结论：冠状动脉疾病行瓣膜手术患者的功能性ICR与MACE升高相关。这些发现支持使用功能评估来指导血运重建决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Asia Cardiology and Cardiovascular Medicine

CiteScore

4.00

自引率

0.00%

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