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October 30.2025

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iMODERN Trial Shows No Advantage of Upfront iFR PCI in STEMI Treatment

3D heart valve model illustrating STEMI outcomes iFR PCI in a medical context.

Understanding the iMODERN Trial Findings

The iMODERN trial, which involved over 1,000 patients, investigated treatment strategies for patients suffering from ST-segment elevation myocardial infarction (STEMI) and multivessel disease. Researchers compared two different approaches: performing immediate percutaneous coronary intervention (PCI) for all nonculprit lesions guided by instantaneous wave-free ratio (iFR) versus a deferred approach based on stress cardiac MRI (CMR). Despite initial expectations, the findings indicated that both strategies yielded nearly identical outcomes after a three-year follow-up.

A Glimpse into the Data

According to the findings presented by Dr. Robin Nijveldt at the Transcatheter Cardiovascular Therapeutics (TCT) annual meeting, the rates of major adverse events, such as death and recurrent heart attacks, were comparable between the two groups. Specifically, the rates stood at 9.3% for the iFR group and 9.8% for the CMR group, leading to the conclusion that immediate PCI may not be necessary for all patients.

Why the Results Matter

These results prompt a reassessment of guidelines advocating for upfront multivessel interventions during the index PCI. The trial emphasizes that cath lab operators can now adopt a more flexible approach. They can prioritize immediate PCI for significant stenoses while deferring less critical treatment until further assessment can be made without compromising patient outcomes.

Clinical Implications and Future Directions

This study's findings represent a significant moment in the field of cardiology. As healthcare continues to evolve, the importance of being non-invasive—and selecting treatment strategies that best fit individual patient situations—cannot be overstated. Prof. Niels van Royen, co-principal investigator of the study, noted that treating additional arteries can be done in one session or staged, aligning treatment with patient needs.

Conclusions and Moving Forward

The iMODERN trial serves as a valuable resource, guiding physicians toward personalized care by confirming the equal effectiveness of both immediate and deferred PCI strategies. This allows for tailored decision-making based on the severity of the coronary lesions and patient stability. As the data is digested, especially with ongoing research like the COMPLETE-2 trial, the cardiology community eagerly anticipates further advancements that can contribute to improved patient care in the face of cardiac emergencies.

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iMODERN Trial Shows No Advantage of Upfront iFR PCI in STEMI Treatment

Understanding the iMODERN Trial Findings

A Glimpse into the Data

Why the Results Matter

Clinical Implications and Future Directions

Conclusions and Moving Forward

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