AIR-STEMI functional angiography cut extra stenting and cardiovascular events
AIR-STEMI used an angiography-derived flow measurement rather than the visual degree of narrowing alone to assess remaining lesions in heart attack people with multivessel disease. The functional approach substantially reduced intervention in non-culprit vessels, while the combined endpoint of death, myocardial infarction, stroke or ischaemia-driven revascularisation also fell. The results sharpen the case for selecting which narrowing actually needs a stent.
Science··Morning
Flow measurement selected which narrowing to treat
AIR-STEMI enrolled 1,823 people at 21 centres in Italy and Pakistan after an ST-segment elevation heart attack. Their culprit artery had been successfully treated, but they also had narrowings in other vessels. In one group, those lesions were assessed with angiography-derived fractional flow reserve and intervention was deferred above 0.80. In the other, intervention was recommended for every vessel narrowed by at least 50 per cent on the image. The trial therefore compared appearance alone with a measure that also captured the effect on blood flow.[1], [2]
Fewer interventions came with a lower event rate
Intervention in non-culprit vessels reached 51.9 per cent in the functional-measurement group and 94.9 per cent with conventional angiography. Over a median 17.9 months, the combined endpoint of death, myocardial infarction, stroke or ischaemia-driven revascularisation fell from 13.7 per cent to 8.9 per cent, with a hazard ratio of 0.62. The safety endpoint of contrast-associated acute kidney injury or major bleeding fell from 7.1 per cent to 4.6 per cent. Overall mortality did not differ significantly: 5.1 per cent against 3.9 per cent.[1]
Central analysis focused treatment on important lesions
Fractional flow reserve analyses were run centrally in a core laboratory. Simone Biscaglia said the team used the approach to select and treat only the non-culprit lesions that were clinically important. The trial was conducted in Italy and Pakistan; its results were presented in a Hot Line session at ESC Congress 2026 and published simultaneously in the New England Journal of Medicine.[1], [2]
