‍⚕️ The Investigator
Prof. Simone Biscaglia (University of Ferrara) led the AIRSTEMI trial – an ESC Hot Line study published in NEJM that establishes functional coronary angiography as the new standard for complete revascularization in STEMI.

🎤 Voices from the ESC Hot Line Highlightes – Prof. Biscaglia:
▪️ Procedural benefits: staged procedures ▼38%, contrast use ▼20%, vessels treated ▼45%, stent length ▼30%
▪️ Primary endpoint (death/MI/CVA/revasc): 8.9% vs 13.7% — ▼38%, p<0.001
▪️ CV death/MI: HR 0.52 — ▼48%
▪️ There was a particularly marked reduction in spontaneous myocardial infarction.
"Functional coronary angiography allowed us to treat only lesions that matter — reducing unnecessary procedures and complications."

⚛️ Study Design
Investigatorinitiated, 21center RCT (Italy/Pakistan). 1,823 STEMI patients with multivessel disease randomized 1:1 to physiologyguided (angiographyderived FFR) or angiographyguided complete revascularization. Median followup: 17.9 months.

🔬 Key Results at a Glance
▪️ Procedural outcomes — physiology vs angiography: nonculprit vessels 51.9% vs 94.9%; staged procedures ▼38%; contrast ▼19%; stent length ▼31%.
▪️ Primary endpoint: 8.9% vs 13.7% — HR 0.62 (p<0.001), NNT 21.
▪️ Secondary: CV death/MI HR 0.52; any MI 0.47; spontaneous MI 0.46; ischemiadriven revasc 0.61.
▪️ Safety: 4.6% vs 7.1% — HR 0.63 (p=0.02).

✅ Why This Matters
The 2023 ESC Guidelines stopped short of strongly endorsing functional evaluation of nonculprit lesions in STEMI — largely due to the FLOWERMI trial (2021), which failed to show superiority of wirebased FFR over angiography (HR 1.32; 95% CI 0.78–2.23; P=0.31).

In the acute STEMI setting, it might be difficult to achieve maximal hyperemia, which compromises wirebased FFR accuracy, likely contributing to FLOWERMI's neutral outcome. Functional coronary angiography including μFR was derived without the need to induce hyperemia. In AIRSTEMI trial, it showed this technology outperformed angiographyguided complete revascularization (HR 0.62, p<0.001).

🚀 AIR-STEMI changes this landscape — and does so with modern tools:
μFR enabled physiology guidance; virtual PCI planning (80.8%) optimized treatment. Functional angiography deferred ~50% of nonculprit lesions — reducing procedures, contrast, and complications, while improving outcomes.

🏛️ Investigatorinitiated, funded by the Italian Health Ministry. Industry support was limited to unrestricted grants and software licenses, with no role in trial conduct — ensuring full scientific independence.


📄Read the full paper: https://lnkd.in/gwUmM59Y

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