Key result
Quantitative flow ratio-guided PCI reduced the 5-year risk of major adverse cardiac events compared with angiography-guided PCI (17.5% vs 21.1%; HR 0.80; 95% CI 0.69-0.92; P=0.002).
Why the study?
Does a QFR-guided PCI strategy reduce major adverse cardiac events compared with an angiography-guided strategy in patients with intermediate coronary lesions?
RCT
sham-controlled
randomized
Yes
Does a QFR-guided PCI strategy reduce major adverse cardiac events compared with an angiography-guided strategy in patients with intermediate coronary lesions?
No takes yet. Share an insight, caveat, or question.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“[Zhang et al.] are commended for conducting and extending follow-up of a large clinical trial comparing angiographic guidance with QFR guidance for PCI – to our knowledge no other comparable trial has been performed or planned.”
QFR-guided PCI improves 5-year clinical outcomes compared to angiography guidance in patients with intermediate coronary lesions, with benefits accruing primarily in the first 2 years.
BACKGROUND: The multicenter, randomized, sham-controlled FAVOR III China trial (Comparison of Quantitative Flow Ratio-Guided and Angiography-Guided Percutaneous Intervention in Patients with Coronary Artery Disease) demonstrated that quantitative flow ratio (QFR)-guided percutaneous coronary intervention (PCI) resulted in better outcomes compared with angiographic guidance at 1-year and 2-year follow-up. Whether these benefits are sustained over long-term follow-up remains uncertain. OBJECTIVES: The purpose of this study was to evaluate the long-term effectiveness and safety of a QFR-guided PCI strategy compared with angiography-guided PCI at 5 years. METHODS: Patients with at least 1 angiographically intermediate coronary lesion (50%-90% diameter stenosis) in a vessel ≥2.5 mm diameter were randomized to a QFR-guided (PCI performed only if QFR ≤0.80) or angiography-guided strategy. The primary endpoint was major adverse cardiac events (a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization) at 1 year; 5-year outcomes data are reported herein. RESULTS: At 5 years, major adverse cardiac events composite was lower with QFR guidance than with angiography guidance (17.5% vs 21.1%; HR: 0.80; 95% CI: 0.69-0.92; P = 0.002), driven by fewer myocardial infarctions (5.8% vs 9.0%; HR: 0.63; 95% CI: 0.49-0.80; P < 0.0001) and ischemia-driven revascularizations (9.6% vs 12.0%; HR: 0.78; 95% CI: 0.64-0.95; P = 0.02) in the QFR-guided group. All-cause death did not differ between groups. Landmark analysis showed that the benefit of QFR guidance accrued predominantly within the first 2 years (8.5% vs 12.5%; HR: 0.66; 95% CI: 0.54-0.81; P < 0.0001), with similar outcomes between 2 and 5 years (10.2% vs 11.2%; HR: 0.90; 95% CI: 0.73-1.11; P = 0.32; P for interaction = 0.001). CONCLUSIONS: Compared with angiography guidance, QFR-guided strategy improved 5-year clinical outcomes, with benefits primarily achieved within the first 2 years. (The FAVOR III China Study; NCT03656848).
Zhang et al. (2026) conducted an RCT in Coronary Artery Disease. Quantitative flow ratio (QFR)-guided percutaneous coronary intervention (PCI) vs. Angiography-guided PCI was evaluated on Major adverse cardiac events (a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization) (HR 0.80, 95% CI 0.69-0.92, p=0.002). Quantitative flow ratio-guided PCI reduced the 5-year risk of major adverse cardiac events compared with angiography-guided PCI (17.5% vs 21.1%; HR 0.80; 95% CI 0.69-0.92; P=0.002).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: