iMODERN Trial Shows Immediate vs. Delayed Heart Attack Treatment Equally Safe, Published in NEJM
Key Insights
The iMODERN trial, the largest global study to date using iFR (search) technology in heart attack patients, found no significant difference in major outcomes between immediate and delayed treatment of additional narrowed arteries over three years.
The study enrolled 1,146 patients across 41 hospitals in 14 countries and was published in The New England Journal of Medicine, confirming both treatment approaches are equally safe and effective.
Complementary ILIAS ANOCA (search) study results demonstrated that physiology-guided coronary function testing significantly improved angina symptoms and quality of life in patients with no obstructive coronary arteries.
The largest global trial to date examining treatment timing for heart attack patients has found that immediate treatment of additional narrowed arteries during the initial procedure is as safe and effective as waiting for a follow-up intervention. The iMODERN trial results, published in The New England Journal of Medicine and presented at the Transcatheter Cardiovascular Therapeutics (TCT) 2025 conference, address a longstanding question in interventional cardiology about optimal timing for complete revascularization.
Study Design and Methodology
The iMODERN trial (Instantaneous wave-free Ratio Guided Multivessel Revascularisation During PCI for Acute Myocardial Infarction) enrolled 1,146 patients across 41 hospitals in 14 countries. Patients were randomly assigned to one of two treatment strategies: immediate physiology-guided treatment of additional narrowed arteries during the first procedure using instantaneous wave-free ratio (iFR (search)), or staged treatment guided by cardiac Magnetic Resonance Imaging (MRI) carried out within four days to six weeks after the heart attack.
The study's primary endpoint combined three major outcomes: death, another heart attack, or hospitalization for heart failure over three years of follow-up.
Key Clinical Findings
After three years of follow-up, the trial found no significant difference in major outcomes between the two treatment approaches. This finding confirms that both immediate and delayed treatment strategies are backed by solid evidence, offering patients more certainty and personalized care options.
"These results address one of the longest-standing questions in interventional cardiology," said Prof. Niels van Royen, co-principal investigator at Radboud University Medical Center, The Netherlands. "Measuring and eventually treating additional arteries can be performed during the first procedure or during a staged procedure. That means cardiologists can feel confident offering patients a complete solution in one sitting when it's appropriate."
Clinical Practice Implications
The findings provide crucial flexibility for real-world practice, where many heart attack patients have multiple diseased arteries beyond the vessel causing the acute event. Currently, additional narrowed arteries are often not treated immediately due to time constraints, patient stability concerns, resource limitations, or because they remain unnoticed.
"Flexibility is critical in real-world practice," added Prof. Dr. Robin Nijveldt, co-principal investigator at Radboud University Medical Center. "Some patients may benefit from immediate treatment, while others are better served by waiting. iMODERN is a pragmatic study that shows that an immediate intervention is not necessarily better than waiting, if patients are offered a CMR to evaluate the need for a second intervention."
Technology and Guideline Integration
The iMODERN trial represents the largest study to date testing iFR (search) in the acute heart attack setting, expanding the evidence base for a tool already strongly recommended (Class I, Level A) in stable patients. By confirming the safety of extending Class I, Level A-recommended iFR to non-stable patients, the results offer physicians the opportunity to complete treatment in one session without compromising long-term outcomes.
"These results complement current international guideline recommendations (Class I recommendation, Level A evidence) for complete revascularization in STEMI (search)," said Dr. Darshan Doshi, practicing interventional cardiologist and Head of Medical & Clinical at Philips Image-Guided Therapy Devices. "By integrating physiological assessment, iMODERN's evidence demonstrates that cardiologists can follow these findings for full revascularization while also tailoring treatment to each vessel's true ischemic relevance."
Complementary ANOCA Study Results
In related findings presented at the same conference, the ILIAS ANOCA (search) study further demonstrated the value of physiology-guided decision-making in patients with angina and no obstructive coronary arteries (ANOCA). The study, conducted across five cardiac centers in the Netherlands and Germany with 153 patients, compared standard care with coronary function testing (CFT)-guided medical therapy using Philips Doppler FloWire and FloMap systems.
The ILIAS ANOCA (search) study found that ad-hoc CFT followed by tailored therapy significantly improved patient-reported angina symptoms and quality of life at six months, with a mean 9.4-point gain in the Seattle Angina Questionnaire summary score (95% CI 3.9–14.9; p=0.001). There were no procedure-related complications or major adverse cardiac events. The 12-month results demonstrated sustained benefits of CFT-guided care.
Technology Platform
Philips physiology solutions, including instantaneous wave-free ratio (iFR (search)) pressure wires and software, were used to guide immediate treatment decisions in the trial. Philips also provided advanced cardiac MRI technology that guided the delayed treatment strategy. The iFR technology is a minimally invasive method to measure blood pressure through the coronary arteries, helping physicians decide which blockages require stenting.