Researchers presenting findings from the AIR-STEMI trial at ESC Congress 2026 said a strategy of complete coronary artery revascularization guided by functional coronary angiography resulted in a lower risk of death, myocardial infarction (MI), cerebrovascular accident, or ischemia-driven revascularization in patients with STEMI and multivessel coronary artery disease compared with conventional angiography.

The trial, which was simultaneously published in NEJM, randomized approximately 1,800 patients (median age 66; 24% women) to either functional coronary angiography or conventional angiography. At a median follow-up of 18 months, a primary outcome event occurred in 4.6% of patients in the functional coronary angiography group vs. 13.7% in the angiography group. A primary safety outcome event of contrast-associated acute kidney injury or major bleeding occurred in 4.6% of those assigned to functional coronary angiography vs. 7.1% of those assigned to conventional angiography.

“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,” said Simone Biscaglia, MD, from the University Hospital of Ferrara in Italy. “By moving beyond visual estimation alone, this approach brings complete revascularization closer to precision medicine: treating the lesions that matter, while avoiding unnecessary PCI in lesions that do not appear to limit blood flow. These results support functional coronary angiography as a new strategy to make complete revascularization more selective, safer and more personalized in this high-risk population.”

The TARGET-CTCA trial, simultaneously published in NEJM, also provided new data on the management and treatment of critical care cardiology patients. Ken Lee, MD, PhD, et al., found that patients with suspected acute coronary syndrome in whom MI had been ruled out, routine CT coronary angiography–guided management did not result in a lower incidence of subsequent MI or cardiovascular-related death compared with standard care.

Meanwhile, in PREC1SE-MI, which was simultaneously published in The Lancet, rapid biomarker testing for MI proved to be as safe as a slower three-hour pathway, but did not reduce the length of emergency department (ED) stays, according to researchers. Of note, neither the faster one-hour pathway nor the slower three-hour pathway reduced the length of time patients were in the ED or lead to an increase in the number of patients directly discharged from the ED.

“We conducted the PRESC1SE-MI trial to determine whether implementation of the 0/1-hour pathway, as compared with continued use of the 0/3-hour pathway, provided similar safety while reducing ED length of stay across diverse health care systems,” said Jasper Boeddinghaus, MD, principal investigator. “These findings are important to health care providers worldwide as they contradict current assumptions that implementing 0/1- hour testing improves patient management in the ED. It seems that other processes – including specialist review, admissions workflow and bed availability.”

Visit ACC’s ESC Congress 2026 coverage page to explore the latest science and key takeaways shaping cardiovascular care.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Imaging, Interventions and Vascular Medicine, Angiography, Computed Tomography, Nuclear Imaging, Chronic Angina

Keywords: ESC Congress, ESC26, Myocardial Infarction, Chest Pain, Troponin, Algorithms, Emergency Service, Hospital, ST Elevation Myocardial Infarction, Coronary Angiography, Percutaneous Coronary Intervention, Tomography, X-Ray Computed