Do differences between quantitative flow ratio (QFR)- and fractional flow reserve (FFR)-guided revascularization persist beyond the first year? The 2-year analysis of the FAVOR III Europe trial, published in EuroIntervention, extends follow-up from a study in which QFR guidance did not meet non-inferiority to FFR guidance at 12 months for the composite of all-cause death, myocardial infarction (MI), and unplanned revascularization. QFR is an angiography-based method for estimating FFR.

FAVOR III Europe was a multicentre, randomized, open-label, non-inferiority trial that enrolled 2,000 patients from 34 European medical centers with intermediate coronary artery stenoses. Patients were randomized to undergo QFR-guided or FFR-guided revascularization. The 2-year analysis assessed major adverse cardiac events (MACE), defined as all-cause death, MI, or unplanned revascularization, along with its individual components.

At 2 years, MACE occurred in 9.7% of patients in the QFR group and 7.4% in the FFR group (hazard ratio [HR] 1.34; 95% confidence interval [CI] 0.98 to 1.81; P=0.064). In the landmark analysis from 1 to 2 years, MACE occurred in 3.2% of patients in both groups (HR 0.97; 95% CI 0.58 to 1.62; P=0.92).

In this analysis, excess risk associated with QFR-guided revascularization was confined to the first year, with similar MACE rates between QFR and FFR from 1 to 2 years.