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AIR-STEMIHot Line 4Interventional CardiologyNew England Journal of Medicine
Functional Versus Conventional Angiography for Complete Revascularization in Multivessel STEMI
Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults
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Presenting authorSimone BiscagliaInterventional / Structural Cardiology · University of FerraraSimone Biscaglia is an Interventional Cardiologist at Ferrara University Hospital and Associate Professor of Cardiology at the University of Ferrara in Italy. He coordinates clinical studies on coronary interventions, intracoronary physiology, imaging, and acute coronary syndromes, including trials such as FIRE and HAWKEYE. His publications include work in The Lancet and New England Journal of Medicine on topics like machine learning prediction of events post-ACS and PCI strategies in older MI patients.
Key result
Functional angiography-guided complete revascularisation reduced death, MI, stroke, or ischaemia-driven revascularisation compared to conventional angiography (HR 0.62; 95% CI 0.47-0.83; p<0.001).
Overview
Awaits full ESC 2026 data; leaves open whether physiology-guided angiography reduces events in STEMI with multivessel disease.
Discussion
AIR-STEMI has reported — post the first read.
Expert takes
Sentiment overview
The AIR-STEMI trial investigates functional coronary angiography in ST-elevation myocardial infarction, presented by Simone Biscaglia.
Key Points
- To determine whether functional coronary angiography-guided complete revascularization improves clinical outcomes compared with conventional angiography-guided revascularization in patients with STEMI and multivessel disease.
- Investigator-initiated multicenter randomized trial involving 1,823 patients with STEMI and multivessel disease after successful culprit-lesion PCI at 21 centres in Italy and Pakistan (median age 66 years; 24% women).
- Participants were randomized to complete revascularization guided by functional coronary angiography (angiography-derived FFR, deferring lesions with FFR >0.80) or conventional angiography (PCI recommended for non-culprit stenosis ≥50%), with a median follow-up of 17.9 months.
- The primary composite outcome of death, myocardial infarction, cerebrovascular accident, or ischaemia-driven revascularisation occurred in 8.9% with functional angiography versus 13.7% with conventional angiography (HR 0.62; 95% CI 0.47–0.83; p<0.001).
- The primary safety outcome of contrast-associated acute kidney injury or major bleeding occurred in 4.6% in the functional angiography group versus 7.1% in the conventional angiography group.
Study Design
Type
RCT (n=1,823)
Multicenter
Yes
Structured PICO
Does complete revascularisation guided by functional coronary angiography reduce cardiovascular events compared to conventional angiography in patients with STEMI and multivessel disease after successful culprit-lesion PCI?
P
Population
1,823 patients with STEMI and multivessel disease after successful culprit-lesion PCI, median age 66 years, followed for a median of 17.9 months.
I
Intervention
Complete revascularisation guided by functional coronary angiography (angiography-derived FFR; lesions with FFR >0.80 deferred)
C
Comparator
Complete revascularisation guided by conventional angiography (PCI recommended for non-culprit stenosis ≥50%)
O
Outcome
Composite of death, myocardial infarction, cerebrovascular accident, or ischaemia-driven revascularisation at a median follow-up of 17.9 monthscomposite
In patients with STEMI and multivessel disease, guiding complete revascularization with functional coronary angiography significantly reduces the risk of major adverse cardiovascular events compared to conventional angiography.
Main Result
Hazard Ratio: 0.62 (95% CI 0.47–0.83)
Absolute Event Rate: 8.9% vs 13.7%
p-value: p=<0.001
Trending Research#1 this week
Presented at ESC 2026 Hot Line; covered by Guardian, Healio, MedPage Today, ESC press; widespread social discussion on primary prevention in elderly; 1000+ media mentions in 48 hours.
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95
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Expert commentary
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