In this prespecified secondary analysis of FAVOR III China, QFR-guided PCI was associated with a lower 3-year MACE rate among patients with multivessel disease, but no significant interaction was observed between treatment effect and MVD status, supporting QFR-guided PCI across MVD strata pending further confirmation.
More than half of the 3825 patients in the intention-to-treat population had multivessel disease.
Among patients with MVD, QFR-guided PCI was associated with a significantly lower 3-year MACE rate than angiography-guided PCI.
Among patients without MVD, the lower 3-year MACE rate with QFR-guided PCI did not reach statistical significance.
The treatment effect of QFR-guided PCI did not differ significantly by MVD status.
Multiple supplementary analyses produced results directionally consistent with the main findings.
The authors conclude that the findings provide longer-term randomized evidence supporting QFR-guided PCI across MVD strata, though further confirmation is warranted.
This study looked at 3,825 people in China who were having a stent procedure (PCI) for blocked heart arteries. Half had their procedure guided by standard X-ray images of the arteries (angiography), and half had it guided by quantitative flow ratio (QFR), a computer-based measure of how much a narrowing actually limits blood flow. The researchers followed them for 3 years and asked whether the benefit differed depending on whether patients had disease in multiple vessels. Among patients with multivessel disease, those in the QFR-guided group had fewer major cardiac events (death, heart attack, or repeat procedure for reduced blood flow): 12.1% vs 18.1%. This was mostly because of fewer heart attacks and repeat procedures. In patients without multivessel disease, the numbers also leaned in favor of QFR (8.6% vs 11.0%), but this difference could have been due to chance. Statistically, the benefit was not clearly different between the two groups of patients. This research suggests that using QFR to guide stenting may help reduce cardiac events over 3 years, including in people with more extensive disease. However, this was a secondary analysis, and the authors say the findings need further confirmation. It does not by itself establish who benefits most.
Zhang H, Shi Y, Guan C, Cui J, Wu X, Chen L, et al.. (2026). Quantitative Flow Ratio- vs Angiography-Guided Percutaneous Coronary Intervention: A Secondary Analysis of the FAVOR III China Trial.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.39926