{
  "abstract": "Importance: Whether the association of quantitative flow ratio (QFR)–guided percutaneous coronary intervention (PCI) with long-term outcomes differs according to multivessel disease (MVD) status is uncertain.\n\nObjective: To assess the association of QFR-guided vs angiography-guided PCI with 3-year outcomes according to MVD status.\n\nDesign, Setting, and Participants: In this prespecified secondary analysis of the FAVOR III China randomized clinical trial, patients were screened across 26 centers in China from December 25, 2018, to January 19, 2020. Eligible participants were adults undergoing PCI for stable or unstable angina or for myocardial infarction (MI) occurring at least 72 hours before screening who had at least 1 lesion with 50% to 90% diameter stenosis in a vessel of 2.5 mm or larger. The analysis compared QFR-guided with angiography-guided PCI according to MVD status. MVD was defined by involvement of at least 2 epicardial vessels or the left main coronary artery. The primary analyses of the current prespecified secondary analysis were completed in October 2024.\n\nInterventions: Randomization 1:1 to QFR-guided PCI or angiography-guided PCI.\n\nMain Outcomes and Measures: The primary end point of the FAVOR III China randomized clinical trial was 1-year major adverse cardiac events (MACE), defined as a composite of all-cause death, MI, and ischemia-driven revascularization. The current analysis evaluated 3-year MACE.\n\nResults: Among 3825 patients in the intention-to-treat population (mean [SD] age, 62.7 [10.0] years; 2699 [70.6%] male), 2066 (54.0%) had MVD. In the MVD cohort, MACE occurred in 124 of 1023 patients (12.1%) in the QFR-guided group and 188 of 1043 patients (18.1%) in the angiography-guided group (hazard ratio, 0.65; 95% CI, 0.52-0.81; P < .001), driven by lower rates of MI and revascularization. In the non-MVD cohort, MACE occurred in 76 of 890 patients (8.6%) and 95 of 869 patients (11.0%), respectively (hazard ratio, 0.77; 95% CI, 0.57-1.04; P = .09). The treatment × MVD interaction was not statistically significant ( P for interaction = .35). The findings of landmark, per-protocol, competing-risk, sensitivity, and hierarchical win-ratio analyses were directionally consistent with the main findings.\n\nConclusions and Relevance: In this prespecified secondary analysis of a randomized clinical trial of patients undergoing PCI, QFR-guided PCI was associated with a lower 3-year MACE rate among patients with MVD; however, no significant interaction was observed between treatment effect and MVD status. These findings provide longer-term randomized evidence supporting QFR-guided PCI across MVD strata and warrant further confirmation.\n\nTrial Registration: ClinicalTrials.gov Identifier: NCT03656848",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China",
    "Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China",
    "Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China",
    "Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China",
    "Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China",
    "Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China",
    "Department of Cardiology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China",
    "Department of Cardiology, Jiangsu Provincial People’s Hospital, Nanjing, China",
    "Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China",
    "Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China",
    "Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China",
    "Medical Research and Biometrics Centre, National Center for Cardiovascular Diseases, Beijing, China",
    "Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China",
    "Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California",
    "Cardiology Section, VA Palo Alto Health Care System, Palo Alto, California",
    "Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China",
    "Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain",
    "Icahn School of Medicine at Mount Sinai, New York, New York",
    "for the FAVOR III China Study Group"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 48,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Han Zhang"
    },
    {
      "affs": [
        0
      ],
      "name": "Yanpu Shi"
    },
    {
      "affs": [
        0
      ],
      "name": "Changdong Guan"
    },
    {
      "affs": [
        0
      ],
      "name": "Jingang Cui"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaofan Wu"
    },
    {
      "affs": [
        2
      ],
      "name": "Lianglong Chen"
    },
    {
      "affs": [
        3
      ],
      "name": "Chengxing Shen"
    },
    {
      "affs": [
        4
      ],
      "name": "Junqing Yang"
    },
    {
      "affs": [
        5
      ],
      "name": "Xuebo Liu"
    },
    {
      "affs": [
        6
      ],
      "name": "Yuanzhe Jin"
    },
    {
      "affs": [
        7
      ],
      "name": "Liansheng Wang"
    },
    {
      "affs": [
        8
      ],
      "name": "Xi Su"
    },
    {
      "affs": [
        9
      ],
      "name": "Qing Yang"
    },
    {
      "affs": [
        10
      ],
      "name": "Zhujun Shen"
    },
    {
      "affs": [
        11
      ],
      "name": "Yanyan Zhao"
    },
    {
      "affs": [
        0
      ],
      "name": "Kefei Dou"
    },
    {
      "affs": [
        0
      ],
      "name": "Weixian Yang"
    },
    {
      "affs": [
        12
      ],
      "name": "Jian’an Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Yongjian Wu"
    },
    {
      "affs": [
        13,
        14
      ],
      "name": "William F. Fearon"
    },
    {
      "affs": [
        15
      ],
      "name": "Shengxian Tu"
    },
    {
      "affs": [
        16
      ],
      "name": "Javier Escaned"
    },
    {
      "affs": [
        0
      ],
      "name": "Shubin Qiao"
    },
    {
      "affs": [
        0
      ],
      "name": "Lei Song"
    },
    {
      "affs": [
        17
      ],
      "name": "Gregg W. Stone"
    },
    {
      "name": "FAVOR III China Study Group"
    },
    {
      "affs": [
        18
      ],
      "name": "Zening Jin"
    },
    {
      "affs": [
        18
      ],
      "name": "Bo Yu"
    },
    {
      "affs": [
        18
      ],
      "name": "Guosheng Fu"
    },
    {
      "affs": [
        18
      ],
      "name": "Yujie Zhou"
    },
    {
      "affs": [
        18
      ],
      "name": "Yundai Chen"
    },
    {
      "affs": [
        18
      ],
      "name": "Jun Pu"
    },
    {
      "affs": [
        18
      ],
      "name": "Xinkai Qu"
    },
    {
      "affs": [
        18
      ],
      "name": "Lijun Guo"
    },
    {
      "affs": [
        18
      ],
      "name": "Yaojun Zhang"
    },
    {
      "affs": [
        18
      ],
      "name": "Qi Zhang"
    },
    {
      "affs": [
        18
      ],
      "name": "Hongwei Pan"
    },
    {
      "affs": [
        18
      ],
      "name": "Jie Mi"
    },
    {
      "affs": [
        18
      ],
      "name": "Fei Ye"
    },
    {
      "affs": [
        18
      ],
      "name": "Xiang Cheng"
    },
    {
      "affs": [
        18
      ],
      "name": "Rongchong Huang"
    },
    {
      "affs": [
        18
      ],
      "name": "Ning Guo"
    },
    {
      "affs": [
        18
      ],
      "name": "Bo Xu"
    },
    {
      "affs": [
        18
      ],
      "name": "Martin B. Leon"
    },
    {
      "affs": [
        18
      ],
      "name": "Ajay J. Kirtane"
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    {
      "affs": [
        18
      ],
      "name": "Patrick W. Serruys"
    },
    {
      "affs": [
        18
      ],
      "name": "William Wijns"
    },
    {
      "affs": [
        18
      ],
      "name": "Stephan Windecker"
    }
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  "bibtex": "https://research.draconitic.com/paper/05x8zjrr40jvx.bib",
  "cited_by": 0,
  "doi": "10.1001/jamanetworkopen.2026.39926",
  "fulltext_url": "https://europepmc.org/articles/PMC13691652",
  "id": "05x8zjrr40jvx",
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  "language": "eng",
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  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
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      "2746|Coronary Interventions and Diagnostics"
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  "pdf_url": "https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2855700/zhang_2026_oi_261081_1792081182.42467.pdf",
  "pmcid": "PMC13691652",
  "pmid": "42911591",
  "published": "2026-10-01",
  "publisher": "American Medical Association (AMA)",
  "ris": "https://research.draconitic.com/paper/05x8zjrr40jvx.ris",
  "sources": [
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      "field": "medicine",
      "origin": "openalex:2746|Coronary Interventions and Diagnostics",
      "subfield": "surgery"
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  "title": "Quantitative Flow Ratio– vs Angiography-Guided Percutaneous Coronary Intervention",
  "title_text": "Quantitative Flow Ratio– vs Angiography-Guided Percutaneous Coronary Intervention",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:14Z",
  "url": "https://research.draconitic.com/paper/05x8zjrr40jvx",
  "venue": "JAMA Network Open",
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