Vessel-Oriented Analysis on the Relationship Between Quantitative-Flow Ratio and Mortality in Patients With Severe Aortic Stenosis and Intermediate Coronary Lesions

Catheter Cardiovasc Interv. 2026 Apr;107(5):1407-1417. doi: 10.1002/ccd.70491. Epub 2026 Jan 29.

Abstract

Background: Quantitative flow ratio (QFR) is effective in predicting mortality in patients undergoing transcatheter aortic valve replacement (TAVR). How QFR reclassifies coronary artery disease (CAD) at vessel-level compared to angiography and how this influences the risk of death, remains undetermined.

Methods: We calculated QFR from consecutive 280 TAVR patients with bystander coronary stenoses. All lesions were managed conservatively. Angiographic CAD was defined by a diameter stenosis ≥ 50%, functional CAD by a QFR ≤ 0.80. The outcome was mortality at 3 years.

Results: Overall, 635 lesions were included. Angiographic CAD was evident in 165 (26.0%), functional CAD in 17 (11.2%) (reclassification: p < 0.001). Angiography/QFR mismatch occurred in 22.5%, mostly in large vessels and lesions located in the proximal left anterior descending (LAD). QFR ≤ 0.80 was an independent predictor of death (HR 2.91, 95% CI 1.94-4.36; p < 0.001). The risk was progressively increased for lower QFR values and positive QFR at LAD site (vs. QFR > 0.80 HR: 3.92, 95% CI 2.78-5.53; p < 0.001; vs. QFR ≤ 0.80 at non-LAD site: HR 2.65, 95% CI 1.07-6.59; p = 0.034).

Conclusions: QFR leads to a significant reclassification of CAD rates at vessel-level and shows a significant prognostic value in patients undergoing TAVR.

Keywords: coronary artery disease; quantitative flow ratio; transcatheter aortic valve replacement.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve Stenosis* / diagnostic imaging
  • Aortic Valve Stenosis* / mortality
  • Aortic Valve Stenosis* / physiopathology
  • Aortic Valve Stenosis* / surgery
  • Aortic Valve* / diagnostic imaging
  • Aortic Valve* / physiopathology
  • Aortic Valve* / surgery
  • Coronary Angiography*
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / mortality
  • Coronary Artery Disease* / physiopathology
  • Coronary Circulation*
  • Coronary Stenosis* / diagnostic imaging
  • Coronary Stenosis* / mortality
  • Coronary Stenosis* / physiopathology
  • Coronary Stenosis* / therapy
  • Coronary Vessels* / diagnostic imaging
  • Coronary Vessels* / physiopathology
  • Female
  • Humans
  • Male
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / mortality
  • Treatment Outcome