- Question
- Does selecting lesions for PCI using the quantitative flow ratio (QFR), an angiography-based estimate of fractional flow reserve, improve clinical outcomes compared with standard angiographic guidance?
- Design
- Multicentre, randomised, blinded, sham-controlled trial conducted at 26 hospitals in China. A total of 3847 patients were enrolled and 3825 formed the intention-to-treat population (1913 QFR-guided, 1912 angiography-guided).
- Population
- Adults aged 18 years or older with stable or unstable angina, or with a myocardial infarction at least 72 h before screening, with at least one lesion of 50-90% diameter stenosis in a vessel with a reference diameter of at least 2.5 mm by visual assessment.
- Intervention
- QFR-guided strategy: PCI was performed only if QFR was ≤0.80.
- Control
- Angiography-guided strategy: PCI based on standard visual angiographic assessment, without other functional testing.
- Primary outcome
- One-year major adverse cardiac events, a composite of death from any cause, myocardial infarction, or ischaemia-driven revascularisation.
- Results
- The primary endpoint occurred in 110 patients (5.8%) in the QFR-guided group and 167 (8.8%) in the angiography-guided group (difference -3.0%, 95% CI -4.7 to -1.4; HR 0.65, 95% CI 0.51 to 0.83; p=0.0004), driven by fewer myocardial infarctions and ischaemia-driven revascularisations in the QFR group.
- Conclusion
- Among patients undergoing PCI, QFR-guided lesion selection improved 1-year clinical outcomes compared with standard angiography guidance.
- Why it matters
- It showed that a functional assessment derived from angiography, without a pressure wire or pharmacological hyperaemia, can guide lesion selection and improve outcomes after PCI.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026