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Updated: May 26, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Functional coronary angiography to indicate and guide revascularization in STEMI patients with multivessel disease:
Andrea Erriquez1, Iginio Colaiori2, Abdul Hakeem3
1Cardiovascular Institute, AOU di Ferrara, Ferrara, Italy.
Insights
The AIR-STEMI trial will compare angiography-guided versus physiology-guided complete revascularization in ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease. This study aims to determine the optimal strategy for improving patient outcomes after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Complete revascularization is superior to culprit-only treatment in ST-segment elevation myocardial infarction (STEMI) with multivessel disease.
- Optimal guidance for complete revascularization (coronary physiology vs. conventional angiography) remains unclear.
- Angiography-derived physiology offers potential for functional assessment and procedural guidance during primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate whether complete revascularization guided by angiography-derived fractional flow reserve (FFR) improves outcomes compared to conventional angiography in STEMI patients with multivessel disease.
- To address the research gap regarding the optimal strategy for complete revascularization in this patient population.
- To provide evidence for guiding clinical practice in STEMI management.
Main Methods:
- Prospective, randomized, international, multicenter, open-label study (AIR-STEMI trial).
- Patients with STEMI and multivessel disease randomized post-culprit lesion PCI to angiography-derived FFR-guided or conventional angiography-guided PCI of non-culprit lesions.
- Primary endpoint: composite of all-cause death, myocardial infarction, cerebrovascular accident, or revascularization at 1-year follow-up. Minimum 1,800 patients enrolled.
Main Results:
- Study is ongoing; results are not yet available.
Conclusions:
- The AIR-STEMI trial will generate novel evidence on the optimal complete revascularization strategy for STEMI patients with multivessel disease.
- Findings will inform clinical decision-making to improve long-term outcomes.
- The study will clarify the role of angiography-derived physiology in guiding PCI for non-culprit lesions.
Background:
Complete revascularization has been shown to be superior to culprit-only treatment in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, it remains unclear whether complete revascularization should be guided by coronary physiology or conventional angiography. Angiography-derived physiology may allow functional assessment and procedural guidance using angiograms from primary percutaneous coronary intervention (PCI), potentially maximizing the benefits of a physiology-guided approach. We present the design of a dedicated study that will address this research gap.
Methods And Design:
The Functional Coronary Angiography to Indicate and Guide Revascularization in STEMI Patients with Multivessel Disease (AIR-STEMI) trial is a prospective, randomized, international, multicenter, open-label study with blinded adjudicated evaluation of outcomes. After successful treatment of the culprit lesion, patients will be randomized to receive PCI of the nonculprit lesions guided by conventional angiography or by angiography-derived fractional flow reserve (FFR). The primary endpoint is the composite endpoint of all-cause death, any myocardial infarction (MI), any cerebrovascular accident, or any revascularization. It will be censored once the last enrolled patient reaches 1-year follow-up. The secondary endpoint will be the composite of cardiovascular death or MI and each single component of the primary endpoint. All endpoints will be tested also at 3 and 5 years. The sample size for the study is a minimum of 1,800 patients.
Implications:
The AIR-STEMI trial will provide novel evidence on whether a specific complete revascularization strategy should be applied to patients with STEMI and multivessel disease to improve their clinical outcomes.
Trial Registration:
ClinicalTrials.gov NCT05818475.
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