Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: BACKGROUND: The preferred timing of treatment of nonculprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. A comparison of immediate percutaneous coronary intervention (PCI) guided by instantaneous wave-free ratio (iFR) and deferred PCI guided by cardiac stress magnetic resonance imaging (MRI) in patients with STEMI and multivessel disease is warranted. METHODS: In this international, investigator-initiated, open-label, randomized, controlled trial, patients with STEMI and at least one nonculprit lesion who had undergone successful primary PCI were randomly assigned in a 1:1 ratio to immediate iFR-guided PCI (in lesions with >50% stenosis and an iFR of ≤0.89 [normal value, >0.89]) or deferred cardiac stress MRI-guided PCI within 6 weeks after randomization. The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3-year follow-up. RESULTS: The trial included 1146 patients (558 in the iFR group and 588 in the MRI group) with a mean (±SD) age of 63±11 years; 78% were men. A total of 237 of 556 patients (42.6%) in the iFR group and 110 of 587 patients (18.7%) in the MRI group underwent nonculprit-lesion coronary-artery PCI. A primary-end-point event occurred in 50 patients (9.3%) in the iFR group and in 55 patients (9.8%) in the MRI group (hazard ratio, 0.95; 95% confidence interval, 0.65 to 1.40; P = 0.81). Serious adverse events occurred in 145 patients in the iFR group and in 181 in the MRI group. CONCLUSIONS: Among patients with STEMI who have undergone successful primary PCI, immediate iFR-guided PCI was not superior to deferred cardiac stress MRI-guided PCI of nonculprit coronary-artery lesions with respect to death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3 years. (Funded by Philips Volcano and others; iMODERN ClinicalTrials.gov number, NCT03298659.).
Source: New England Journal of Medicine
Authors: Robin Nijveldt, Michael Maeng, Casper W.H. Beijnink, Jan J. Piek, Rasha K. Al-Lamee, Luís Raposo, Sergio Bravo Baptista, Javier Escaned, Justin Davies, Igor Klem, Bahram Yosofi, Robert-Jan M. van Geuns, Christian A. Frederiksen, Lars Jakobsen, Abdelilah El Barzouhi, Dirk J. van der Heijden, Mustafa Ilhan, Saman Rasoul, Stijn Brinckman, Colette Saraber, Daniel A. Jones, Steffen E. Petersen, Tomaž Podlesnikar, Matjaž Bunc, Marcel A.M. Beijk, Lieuwe H. Piers, Johannes B. van Rees, Henry Seligman, Graham Cole, Juan F. Iglesias, Sophie Degrauwe, Arnoud W.J. van ’t Hof, Erik Lipsic, Gabija Pundziute-do Prado, Pairoj Chattranukulchai, José F. Rodríguez-Palomares, Johannes Rigger, Martijn Meuwissen, Lennaert Kleijn, Bruno Pereira, Lorenzo Monti, René J. van der Schaaf, Juan Sanchis, Guido Belli, Jan G.P. Tijssen, Troels Thim, Niels van Royen
Institutions: Radboud University Medical Center, Aarhus University, Aarhus University Hospital, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Imperial College London, Hospital de Santa Cruz, University of Lisbon, Hospital Prof. Dr. Fernando Fonseca, Centro Cardiovascular da Universidade de Lisboa, Unidade Local de Saúde de Amadora/Sintra, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Centro de Investigación en Red en Enfermedades Cardiovasculares, Centro de Investigación Biomédica en Red, Princess Grace Hospital Centre, Duke Medical Center, Medisch Centrum Haaglanden, Stichting Haaglanden Medisch Centrum, Isala, Maastricht University Medical Centre, Maastricht University, Zuyderland Medisch Centrum, Tergooi, St Bartholomew's Hospital, Barts Health NHS Trust, William Harvey Research Institute, Queen Mary University of London, Ljubljana University Medical Centre, University Clinical Centre Maribor, Rijnstate Hospital, University Hospital of Geneva, University Medical Center Groningen, University of Groningen, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Universitat Autònoma de Barcelona, Instituto de Salud Carlos III, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Kantonsspital St. Gallen, Amphia Ziekenhuis, Treant Zorggroep, Istituti Clinici Scientifici Maugeri, Hospital Clínico Universitario de Valencia, Universitat de València
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Philips, King Chulalongkorn Memorial Hospital, Queen Mary University of London, National Institute for Health and Care Research, Rijksuniversiteit Groningen, Chulalongkorn University, Universitat de València, Biotronik, Universitair Medisch Centrum Groningen, Hôpitaux Universitaires de Genève, Universitat Autònoma de Barcelona, Ministerie van Economische Zaken en Klimaat, Barts Health NHS Trust, Instituto de Salud Carlos III, Faculty of Medicine, Chulalongkorn University
Award: G4962226106
OpenAlex ID: W4415634248