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Angiographic Quantitative Flow Ratio-Guided Coronary Intervention: 5-Year Follow-Up From the FAVOR III China
Han Zhang1, Changdong Guan1, Zening Jin2
1Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Quantitative flow ratio (QFR)-guided percutaneous coronary intervention (PCI) showed sustained long-term benefits over angiography guidance in the FAVOR III China trial. These improvements in major adverse cardiac events were mainly observed within the first two years post-procedure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- The FAVOR III China trial previously showed superior outcomes for quantitative flow ratio (QFR)-guided percutaneous coronary intervention (PCI) compared to angiography guidance at 1 and 2 years.
- Long-term sustainability of these QFR benefits remained undetermined.
Purpose of the Study:
- To assess the 5-year clinical effectiveness and safety of a QFR-guided PCI strategy versus traditional angiography-guided PCI.
Main Methods:
- A multicenter, randomized trial comparing QFR-guided PCI (intervention if QFR ≤0.80) with angiography-guided PCI.
- Inclusion criteria: patients with intermediate coronary lesions (50%-90% diameter stenosis) in vessels ≥2.5 mm.
- Primary endpoint: major adverse cardiac events (MACE) at 1 year; 5-year outcomes reported.
Main Results:
- At 5 years, QFR guidance significantly reduced MACE (17.5% vs 21.1%, HR 0.80, P=0.002).
- This reduction was driven by fewer myocardial infarctions and ischemia-driven revascularizations in the QFR group.
- Benefits of QFR guidance were predominantly observed within the first 2 years, with similar outcomes between 2 and 5 years.
Conclusions:
- QFR-guided PCI significantly improves 5-year clinical outcomes compared to angiography guidance.
- The primary benefits of QFR guidance are achieved within the initial 2 years following PCI.
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).
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