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

Coronary angiography remains standard for assessing lesions in valve surgery patients with concomitant coronary artery disease. This study assessed the prognostic value of functional evaluation using quantitative flow ratio in these patients. 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). 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. 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.