SnackableHealth™ | iMODERN: iFR and Cardiac MRI Show Comparable Outcomes in Guiding Non-Culprit Revascularization After STEMI

In this SnackableHealth™ discussion at TCT 2025, Dr. Robin Nijveldt and Dr. C. Michael Gibson reviewed findings from the iMODERN trial, a head-to-head comparison between instantaneous wave-free ratio (iFR) and cardiac magnetic resonance imaging (MRI) guidance for non-culprit lesion revascularization in patients presenting with ST-segment elevation myocardial infarction (STEMI).

Dr. Nijveldt explained that the optimal strategy for treating non-culprit lesions after primary PCI remains debated. Physiologic indices like iFR offer real-time assessment of lesion significance, whereas cardiac MRI provides a more comprehensive view of myocardial viability and ischemic burden. “The iMODERN trial was designed to test whether functional or imaging-based approaches yield different long-term outcomes,” he noted.

The study showed no significant difference in major adverse cardiovascular events (MACE) between iFR- and MRI-guided strategies, confirming that both approaches are safe and effective for determining the need for staged revascularization. Importantly, MRI-guided treatment led to fewer interventions without compromising outcomes, suggesting that some non-culprit lesions may not require immediate PCI.

Dr. Gibson highlighted that this balance between physiology and imaging is essential in modern STEMI care. “iMODERN demonstrates that precision can come from either side — physiology when rapid decision-making is needed, or imaging when myocardial context is key,” he commented.

Both experts agreed that future trials integrating physiology and imaging modalities could refine patient selection even further, optimizing the extent and timing of revascularization in multivessel STEMI.