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News
A smarter way to treat heart attacks just got a big endorsement. The AIR-STEMI trial found that using angiography-based functional assessment — no wire needed — to guide complete revascularization in STEMI patients with multivessel disease slashed the risk of major adverse events by 38% compared to conventional angiography alone. Experts are already calling it "practice changing."
A smarter way to treat heart attacks just got a big endorsement. The AIR-STEMI trial, presented at the European Society of Cardiology Congress 2026 and published in the New England Journal of Medicine, found that using angiography-derived functional assessment — without the need for a pressure wire — to guide complete revascularization in STEMI patients with multivessel disease significantly outperformed conventional angiography alone.
The trial randomized 1,823 STEMI patients with multivessel disease. In the physiology-guided group, angiograms were analyzed by a central core lab using quantitative flow ratio tools to assess nonculprit vessels, helping operators decide which lesions truly warranted stenting. The result: fewer unnecessary procedures, less contrast use, and better outcomes across the board.
By the numbers:
Why it matters: This trial offers a practical, wire-free path to physiological assessment during primary PCI — addressing a longstanding gap where wire-based methods were cumbersome and prior trials conflicted. With ACS guideline updates expected next year, AIR-STEMI could reshape how interventional cardiologists approach complete revascularization.
