Prognostic Value of Functional Incomplete Revascularization for Intermediate Coronary Stenosis in Patients With Valvular Surgery

ABSTRACT Objective This study sought to investigate the prognostic impact of functional incomplete revascularization (ICR) in patients undergoing primary valvular surgery with concomitant intermediate coronary stenosis. Methods We conducted a retrospective cohort study of consecutive patients undergoing valvular surgery with concomitant intermediate stenosis in ≥1 main coronary artery, defined as diameter stenosis within 50% and 70%. Angiography derived Murry law based single view quantitative flow reserve (μQFR) was analyzed post hoc in a blinded fashion. Functional ICR per vessel was defined as vessel μQFR ≤ 0.8 and no bypass graft planted. The major adverse cardiac outcome was defined as a composite of all‐cause death, myocardial infarction, unplanned coronary revascularization, and stroke. Results A total of 486 patients were enrolled. Overall, 17.7% (86/486) patients remained functional ICR after surgery. The overall incidence of MACE was 14.2% during an average follow‐up time of 3.4 years. Adjusted Cox regression analysis showed that patients with functional ICR had a higher risk of MACE (HR 1.78, 95% CI 1.05−3.00, p = 0.031) and revascularization (HR 4.69, 95% CI 1.13−19.48, p = 0.033) than those with functional CR. Conclusions Functional ICR of intermediate coronary stenosis (50%−70%) in patients undergoing a primary valvular surgery portended a higher risk of MACE. Functional assessment of intermediate coronary stenosis should be taking into consideration on proceeding to myocardial revascularization.