Outcome Impact of Quantitative Flow Ratio-guided Revascularization in Elderly Patients With Coronary Artery Disease Undergoing Valve Surgery
10.3969/j.issn.1000-3614.2025.09.006
- VernacularTitle:基于定量血流分数的血运重建对≥70岁的接受心脏瓣膜手术的冠心病患者的预后影响
- Author:
Fang ZHANG
1
;
Wei GAO
;
Wenshuo WANG
;
Jinying ZHOU
;
Jingpu WANG
;
Qiyu ZHANG
;
Rende XU
;
Chunsheng WANG
;
Chenguang LI
;
Junbo GE
Author Information
1. 上海理工大学 健康科学与工程学院,上海 200093;复旦大学附属中山医院 心血管内科 上海心血管病研究所,上海 200032
- Publication Type:Journal Article
- Keywords:
valve surgery;
coronary artery disease;
coronary artery bypass grafting;
fractional flow reserve;
quantitative flow ratio;
functional assessment
- From:
Chinese Circulation Journal
2025;40(9):878-884
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:This study aimed to investigate the impact of quantitative flow ratio(QFR)-guided revascularization on outcome of elderly patients with coronary artery disease(CAD)undergoing valve surgery.Methods:We retrospectively analyzed 750 consecutive patients with angiographically confirmed CAD(≥50%stenosis)who underwent valve surgery at Zhongshan Hospital,Fudan University,between January 2016 and December 2021.According to the patients'ages,they were divided into the younger group(age<70 years old,n=532)and the elderly group(age≥70 years old,n=218).Revascularization strategies were evaluated using anatomical(angiography-based)and functional(QFR-based)criteria.Anatomical complete revascularization(CR)was defined as bypass grafting for all lesions with≥70%diameter stenosis in major coronary arteries or≥50%stenosis in the left main coronary artery.Functional CR referred bypass grafting for all lesions with QFR≤0.80.Incomplete revascularization(ICR)was defined as failure to meet CR criteria.According to the anatomical and functional definitions,the younger group and the elderly group were further divided into the incomplete revascularization subgroup and the complete revascularization subgroup respectively.Major adverse cardiovascular events(MACE),including death,myocardial infarction,repeat revascularization,and stroke,were assessed as the composite endpoint.Results:Over a follow-up of(3.7±1.8)years,the overall MACE rate was 13.3%.The younger group exhibited significantly lower MACE rates than the elderly group(10.7%vs.19.7%,P=0.001).In the younger group,anatomical ICR did not increase MACE risk(HR=1.46,95%CI:0.81-2.62,P=0.164),whereas functional ICR significantly increased MACE risk(HR=2.27,95%CI:1.24-4.15,P=0.001).In the elderly group,neither anatomical ICR(HR=1.22,95%CI:0.62-2.41,P=0.540)nor functional ICR(HR=1.52,95%CI:0.78-2.96,P=0.172)was associated with increased MACE risk.Conclusions:In patients undergoing valve surgery with CAD,functional ICR correlated with adverse outcomes in the younger group,whereas neither anatomical nor functional ICR significantly affected prognosis in elderly patients.These findings suggest that a moderately conservative revascularization strategy may be more appropriate for elderly populations.
