Quantitative Flow Ratio– vs Angiography-Guided Percutaneous Coronary Intervention

@article{zhang2026quantitative,
  title = {{Quantitative Flow Ratio– vs Angiography-Guided Percutaneous Coronary Intervention}},
  author = {Han Zhang and Yanpu Shi and Changdong Guan and Jingang Cui and Xiaofan Wu and Lianglong Chen and Chengxing Shen and Junqing Yang and Xuebo Liu and Yuanzhe Jin and Liansheng Wang and Xi Su and Qing Yang and Zhujun Shen and Yanyan Zhao and Kefei Dou and Weixian Yang and Jian’an Wang and Yongjian Wu and William F. Fearon and Shengxian Tu and Javier Escaned and Shubin Qiao and Lei Song and Gregg W. Stone and FAVOR III China Study Group and Zening Jin and Bo Yu and Guosheng Fu and Yujie Zhou and Yundai Chen and Jun Pu and Xinkai Qu and Lijun Guo and Yaojun Zhang and Qi Zhang and Hongwei Pan and Jie Mi and Fei Ye and Xiang Cheng and Rongchong Huang and Ning Guo and Bo Xu and Martin B. Leon and Ajay J. Kirtane and Patrick W. Serruys and William Wijns and Stephan Windecker},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.39926},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855700},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Quantitative Flow Ratio– vs Angiography-Guided Percutaneous Coronary Intervention
AU  - Han Zhang
AU  - Yanpu Shi
AU  - Changdong Guan
AU  - Jingang Cui
AU  - Xiaofan Wu
AU  - Lianglong Chen
AU  - Chengxing Shen
AU  - Junqing Yang
AU  - Xuebo Liu
AU  - Yuanzhe Jin
AU  - Liansheng Wang
AU  - Xi Su
AU  - Qing Yang
AU  - Zhujun Shen
AU  - Yanyan Zhao
AU  - Kefei Dou
AU  - Weixian Yang
AU  - Jian’an Wang
AU  - Yongjian Wu
AU  - William F. Fearon
AU  - Shengxian Tu
AU  - Javier Escaned
AU  - Shubin Qiao
AU  - Lei Song
AU  - Gregg W. Stone
AU  - FAVOR III China Study Group
AU  - Zening Jin
AU  - Bo Yu
AU  - Guosheng Fu
AU  - Yujie Zhou
AU  - Yundai Chen
AU  - Jun Pu
AU  - Xinkai Qu
AU  - Lijun Guo
AU  - Yaojun Zhang
AU  - Qi Zhang
AU  - Hongwei Pan
AU  - Jie Mi
AU  - Fei Ye
AU  - Xiang Cheng
AU  - Rongchong Huang
AU  - Ning Guo
AU  - Bo Xu
AU  - Martin B. Leon
AU  - Ajay J. Kirtane
AU  - Patrick W. Serruys
AU  - William Wijns
AU  - Stephan Windecker
PY  - 2026
DA  - 2026/10/01
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.39926
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855700
AB  - 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.  Objective: To assess the association of QFR-guided vs angiography-guided PCI with 3-year outcomes according to MVD status.  Design, 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.  Interventions: Randomization 1:1 to QFR-guided PCI or angiography-guided PCI.  Main 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.  Results: 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.  Conclusions 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.  Trial Registration: ClinicalTrials.gov Identifier: NCT03656848
SN  - 2574-3805
ER  -