Xu B, Tu S, Song L, et al. - Improved 1-year clinical results in patients receiving percutaneous coronary intervention (PCI) were achieved using a quantitative flow ratio (QFR)-guided strategy of lesion selection vs standard angiography guidance.

• A multicentre, blinded, randomised, sham-controlled trial (FAVOR III China) was conducted to determine if clinical results might be improved by lesion selection for PCI employing QFR, a novel angiography-based approach to quantify the fractional flow reserve.

• Eligible patients (aged 18 years or older) with stable or unstable angina pectoris or those who had a myocardial infarction at least 72 h prior to screening were randomized to a QFR-guided strategy (n=1913) (PCI done only if QFR ≤0·80) or an angiography-guided strategy (n=1912) (PCI relied on standard visual angiographic evaluation).

• The 1-year rate of major adverse cardiac events, a composite of death from any cause, myocardial infarction, or ischaemia-driven revascularisation, was assessed (primary endpoint).

• In the QFR-guided and angiography-guided groups, 1-year primary endpoint occurred in 5·8% (Kaplan-Meier estimated rate) and in 8·8% participants, respectively (difference, –3·0%; hazard ratio 0·65), driven by fewer myocardial infarctions and ischaemia-driven revascularisations in the QFR-guided vs angiography-guided group.