Angio fractional flow reserve (FFR)-guided coronary artery bypass grafting (CABG) has significant clinical benefits compared with coronary angiography (CAG)-guided CABG in patients with concomitant coronary artery disease (CAD), a new study shows. Qiang Zhao, MD, from the Ruijin Hospital Shanghai Jiao Tong University School of Medicine, China, presented these findings on behalf of the FAVOR-4 study investigators during a late-breaking clinical science session on Saturday at the American Heart Association (AHA) Scientific Sessions 2025 in New Orleans. Nearly 20% of patients undergoing surgical valve procedures have CAD. CABG is currently recommended by guidelines for these patients, but no evidence is readily available for supporting the benefits of functionally guided isolated CABG. The investigators in this study examined post-procedural outcomes in patients with CAD who underwent valve surgery either with AngioFFR-guided (AngioPlus, Pulse Medical, Shanghai) CABG or CAG-guided CABG. The FAVOR IV-QVAS is an investigator-initiated, multicenter, triple-blind, randomized clinical trial taking place across 12 sites in China. Exclusion criteria were prior cardiac surgery, planned staged percutaneous coronary intervention (PCI), secondary valve disease, cardiogenic shock or a life expectancy of less than 3 years. A composite of all-cause death, myocardial infarction (MI) stroke, unplanned revascularization and new renal failure requiring dialysis within 30 days post-surgery at 30 days was the primary outcome in this study. A key secondary outcome in the study was a composite of all-cause death, MI, stroke, unplanned revascularization, rehospitalization for unstable angina and rehospitalization for heart failure (HF) at 1-year follow-up. A total of 396 patients were included in a modified intention-to-treat analysis in the AngioFFR group (mean age=65 years, 28% female) and 396 patients in the CAG-guided group (mean age=65 years, 28% female), and 74% of patients in both groups had degenerative valve etiology. At 30-days post-procedure, 7.8% of patients in the AngioFFR group and 13.4% of patients in the CAG-guided group experienced a component of the primary endpoint (95% confidence interval [CI]=0.38-0.89, p=0.01). Results of the key secondary outcome demonstrated that patients in the AngioFFR group had fewer events than the CAG-guided group (82 events vs 106 events) (hazard ratio [HR]=0.74, 95% CI=0.55-0.98, p=0.04). Overall, these findings demonstrate the safety and clinical benefits of AngioFFR-guided CABG versus CAG-guided CABG. “These findings support a potential change in practice — using physiological assessment to guide surgical coronary revascularization in patients undergoing valve procedures,” Dr. Zhao concluded during his AHA presentation. Image Credit: Image by Qiang Zhao, MD, during a presentation on Saturday at AHA 2025.