A major international trial presented at the European Society of Cardiology Congress has found that using blood flow measurements to guide treatment decisions in heart attack patients with multiple blocked arteries reduces the risk of serious cardiovascular events compared with standard imaging alone.
The findings come from the AIR-STEMI trial, published by the New England Journal of Medicine, and were presented at ESC Congress. The trial focused on patients experiencing an ST-segment elevation myocardial infarction (STEMI) — a severe type of heart attack caused by a complete blockage in a coronary artery — who also had disease in more than one artery. This combination is common and presents doctors with a difficult decision: treat only the artery that caused the heart attack, or also treat the others?
The trial tested whether using physiology-guided angiography — a technique that measures the pressure and blood flow inside arteries to identify which blockages are genuinely restricting circulation — produced better outcomes than conventional angiography-guided treatment, which relies on visual assessment of the arteries through X-ray imaging. According to the New England Journal of Medicine, patients in the physiology-guided group had a lower rate of major cardiovascular events.
The distinction matters in practice. Not every narrowed artery seen on a scan is causing a significant reduction in blood flow, and treating arteries that don’t need intervention carries its own risks. Physiology-guided assessment gives clinicians a more precise picture of which blockages require a stent or other treatment.
The results were shared by the NEJM at ESC Congress, one of the largest cardiology conferences in the world.
For Kent residents, cardiac care is provided through NHS Kent and Medway, with specialist heart attack services at centres including Maidstone and Tunbridge Wells NHS Trust and Medway NHS Foundation Trust. Decisions about which treatment approach to use in individual cases remain a matter for the clinical teams involved.
Anyone experiencing chest pain, pressure, or tightness should call 999 immediately. For non-emergency cardiac concerns, contact your GP or call NHS 111.
Source: @NEJM