Clinical Impact & Takeaways This is the first large-scale randomised trial comparing QFR vs FFR for guiding PCI in intermediate lesions. QFR did not demonstrate non‑inferiority; the higher MACE rate—especially MI and unplanned revascularisations—raises concerns about its standalone use when FFR is available. Procedural implications: higher overtreatment (excess stenting) in QFR group, particularly in LCx territory. Clinical context: while QFR may still be preferable to angiography alone (as shown in China), FFR should remain the standard when available. Guideline implications: Results may prompt reassessment of the 2024 ESC’s class I/B endorsement of QFR in stable coronary syndromes. Future research: Needed on vessel-specific QFR performance, operator variability, gray-zone strategies, and long-term outcomes of deferred lesions . Reference Andersen BK, Sejr-Hansen M, Maillard L, et al. Quantitative flow ratio versus fractional flow reserve for coronary revascularisation guidance (FAVOR III Europe): a multicentre, randomised, non-inferiority trial. Lancet. 2024;404(10465):1835–1846. doi:10.1016/S0140‑6736(24)02175‑5.