AIR-STEMI Trial Shows Physiology-Guided Complete Revascularisation Reduced Cardiovascular Events In Patients With STEMI And Multivessel Disease

Mumbai, Maharashtra, India: Sahajanand Medical Technologies (SMT) highlighted results from AIR-STEMI, an investigator-initiated, multicentre, randomised clinical trial in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease. The trial found that functional coronary angiography-guided complete revascularisation resulted in a lower risk of major cardiovascular events and improved procedural safety compared with conventional angiography-guided complete revascularisation. The results were presented in a Hot Line session at ESC Congress 2026 and published simultaneously in The New England Journal of Medicine.

After urgent percutaneous coronary intervention (PCI) of the artery responsible for a STEMI, clinicians must decide which additional, non-culprit coronary lesions require treatment. Conventional angiography shows the anatomy of a narrowing but does not always establish whether it restricts blood flow. AIR-STEMI assessed whether physiology derived from angiographic images could identify functionally important lesions for treatment while allowing non-flow-limiting lesions to be safely deferred.

The study enrolled 1,823 patients with STEMI and multivessel coronary disease after successful culprit-lesion PCI. Participants were randomised to complete revascularisation guided by 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, while 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 (8.9%) patients in the physiology-guided group and 125 patients (13.7%) in the angiography-guided group (hazard ratio 0.62; 95% confidence interval 0.47–0.83; p<0.001). This corresponds to a 35% relative reduction in the risk of the primary endpoint.

The main safety endpoint of contrast-associated acute kidney injury or major bleeding occurred in 4.6% (42 patients) in the physiology-guided group and 7.1% (65 patients) in the angiography-guided group (hazard ratio 0.63; 95% confidence interval 0.43–0.93; p=0.02). Non-culprit vessels underwent PCI in 51.9% of cases in the physiology-guided group, compared with 94.9% in the angiography-guided group, resulting in fewer procedures, fewer treated vessels, and lower use of contrast agents.

Associate Professor Simone Biscaglia of University Hospital of Ferrara, Italy, who presented the study at ESC said, “Functional coronary angiography allowed us to select and treat only those non-culprit lesions that were clinically important, reducing unnecessary procedures and the risk of complications. Physiology-guided angiography also provided important information that helped the operator to plan their non-culprit procedures, improving efficacy.”

Professor Gianluca Campo of the University Hospital of Ferrara, and senior author on the manuscript, stated, “The AIR-STEMI findings demonstrate how physiology-guided decision-making can make complete revascularisation more precise while reducing unnecessary procedures and complications.”

Dr Krishna Sudhir, Chief Medical Officer, SMT added, “We are honoured that Supraflex Cruz was the recommended stent platform in this important investigator-initiated trial. The study evaluated revascularisation strategies—not competing stent platforms—but its inclusion reflects the role of Supraflex Cruz in contemporary, evidence-based PCI and the importance of combining innovative strategies and technologies to improve patients’ outcome.”

AIR-STEMI evaluated two strategies for guiding complete revascularisation; it was not a randomised comparison of stent platforms. The results therefore should not be interpreted as establishing the comparative safety or effectiveness of Supraflex Cruz against another stent. Its recommendation within this major contemporary trial nevertheless places the platform in an important clinical research setting involving STEMI and multivessel disease.

About the AIR-STEMI trial

AIR-STEMI was an investigator-initiated, multicentre, prospective, randomised superiority trial involving 1,823 patients with STEMI and multivessel coronary artery disease after successful culprit-lesion PCI. It compared functional coronary angiography-guided complete revascularisation with conventional angiography-guided complete revascularisation. The study was presented during Hot Line 4 at ESC Congress 2026 on 29 August 2026 and published simultaneously in The New England Journal of Medicine.

About SMT (Sahajanand Medical Technologies Limited)

SMT (Sahajanand Medical Technologies Limited) is a global cardiovascular medical devices company with a portfolio spanning vascular and structural heart interventions. SMT combines research and development, precision manufacturing and clinical evidence to address evolving needs in cardiovascular care. Guided by its mission, “Pledged to Save Millions,” the company is committed to making quality cardiovascular care more accessible and affordable worldwide.

For further updates, please visit the website or follow SMT on LinkedIn.

AIR-STEMI trial: Functional Coronary Angiography in STEMI, Hot Line 4, ESC Congress 2026, 29 August 2026.

Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44:3720–3826.