The investigator-initiated, multicentre, randomised trial also reported improved procedural safety with the physiology-guided approach. Its findings were presented during a Hot Line session at ESC Congress 2026 and published simultaneously in The New England Journal of Medicine.
The study addressed a critical decision faced by clinicians after urgent percutaneous coronary intervention (PCI) to treat the artery responsible for a STEMI. Following the procedure, doctors must determine which additional, non-culprit coronary lesions require treatment. Although conventional angiography reveals the anatomy of a narrowing, it does not always establish whether the narrowing restricts blood flow.
AIR-STEMI investigated whether physiology derived from angiographic images could help identify functionally important lesions that require treatment while allowing non-flow-limiting lesions to be safely deferred.
The trial enrolled 1,823 patients with STEMI and multivessel coronary artery disease following successful culprit-lesion PCI. Participants were randomly assigned to undergo complete revascularisation guided by either functional coronary angiography or conventional angiography.
In the physiology-guided group, eligible non-culprit lesions with an angiography-derived fractional flow reserve value of 0.80 or less were treated with PCI. Lesions with a value above 0.80 were deferred.
Supraflex Cruz, SMT’s sirolimus-eluting, biodegradable-polymer drug-eluting stent, was the recommended stent platform within the trial.
At a median follow-up of 17.9 months, the primary composite endpoint of all-cause death, myocardial infarction, cerebrovascular accident (stroke or transient ischemic attack) or ischaemia-driven coronary revascularisation occurred in 81 patients (8.9%) in the physiology-guided group, compared with 125 patients (13.7%) in the angiography-guided group.
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