OBJECTIVE To compare the consistency of angiography-guided and fractional flow reserve (FFR)-guided management strategy for intermediate coronary lesions. METHODS The patients whose coronary intermediate lesions were assessed by measuring FFR from November 2012 to August 2014. The stenosis percentage and value of FFR during the procedure were collected. All the image data were collected and four experienced interventional cardiologists were invited to assess the target lesions and make a management strategy independently. The consistency of angiography-guided and fractional flow reserve-guided management strategy were analyzed. RESULTS In the study, 151 patients were included, of whom, 70.2% were male, the average age was (62.7±9.6) years, 169 vessels were assessed by measuring FFR, 1 being left main, 116 left anterior descending, 27 left circumflex branch, and 25 right coronary artery. There were some correlationship between the stenosis percentage judged by four interventional cardiologists and the stenosis percentage judged during the procedure (r=0.29-0.38, P<0.001), but the difference was significant. When 0.80 was used as FFR threshold value, the consistency rates of angiography-guided management strategy decision made by the four cardiologists with fractional flow reserve-guided management strategy were 72.78%, 71.60%, 75.15%, and 72.78%, respectively. CONCLUSION Angiography-guided management strategy decision is unreliable, FFR is recommended for management strategy decision for intermediate coronary lesions.