Late-breaking iMODERN findings presented at TCT 2025 and published in the New England Journal of Medicine highlight new evidence to guide treatment choices for heart attack patients
- Oct 28, 2025
- 4 minute read
At a glance
3-Year data from the largest global trial to date using Class I, Level A iFR in heart attack patients shows treating additional stenoses in the same procedure showed no significant difference in major outcomes compared with waiting for follow-up
Additional results from the ILIAS ANOCA study highlight the sustained benefits of physiology-guided assessment and tailored medical therapy for patients with angina and no obstructive coronary arteries
Amsterdam, the Netherlands – Royal Philips (NYSE: PHG, AEX: PHIA), a global leader in health technology, today announced late-breaking results from the iMODERN trial (Instantaneous wave-free Ratio Guided Multivessel Revascularisation During PCI for Acute Myocardial Infarction) at the Transcatheter Cardiovascular Therapeutics (TCT) 2025 conference, the world’s leading meeting for interventional cardiology. The study compared immediate versus deferred treatment of additional narrowed arteries in heart attack patients to determine whether treating all blockages in a single procedure is superior to waiting for a follow-up procedure – a key question, since many patients have multiple diseased arteries and the optimal timing for complete treatment remains uncertain.
In today’s practice, when patients suffer a serious type of heart attack (STEMI), cardiologists urgently open the blocked artery causing the attack. But many of these patients also have disease in other arteries. Often these additional narrowed arteries are not treated right away, either due to time restraints, patient stability, resource constraints or because they stay unnoticed. They may be treated later in a separate hospital stay or not at all, leaving uncertainty about the best timing and approach.
The new findings show that patients can safely have additional arteries treated immediately during the first procedure to treat the acute event, rather than during a later second intervention. 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. The iMODERN trial is the largest study to date testing iFR* in the acute heart attack setting, expanding the evidence base for a tool already strongly recommended (Class I, Level A) in stable patients.
The findings are published in The New England Journal of Medicine (NEJM), underscoring its global scientific significance and impact on cardiology practice.
“These results address one of the longest-standing questions in interventional cardiology,” said Prof. Niels van Royen, co-principal investigator, 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.”
The iMODERN study enrolled 1,146 patients across 41 hospitals in 14 countries directly addressed this question. Patients were randomly assigned to one of two treatment strategies: either immediate physiology-guided treatment of additional narrowed arteries during the first procedure using instantaneous wave-free ratio (iFR), 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 main endpoint combined three outcomes: death, another heart attack, or hospitalization for heart failure over three years. After three years of follow-up, the trial found no significant difference in major outcomes – including death, repeat heart attack, or hospitalization for heart failure – between the two approaches. By confirming that both approaches are backed by solid evidence, the trial offers patients more certainty and more personalized care.
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, giving physicians the evidence they need to tailor decisions to each patient.
Dr. Robin Nijveldt
“Flexibility is critical in real-world practice,” added Prof. Dr. Robin Nijveldt, co-principal investigator, at Radboud University Medical Center, in the Netherlands. “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, giving physicians the evidence they need to tailor decisions to each patient.”
“These results complement current international guideline recommendations (Class I recommendation, Level A evidence) for complete revascularization in STEMI,” 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 evidence from ILIAS ANOCA
In related findings presented at the same conference, the ILIAS ANOCA (Inclusive Invasive Physiological Assessment in Angina Syndromes – Angina with No Obstructive Coronary Artery Disease) study further demonstrated the value of physiology-guided decision-making — this time in patients with angina and no obstructive coronary arteries (ANOCA). The ILIAS ANOCA study evaluated the impact of coronary function testing (CFT) in patients whose coronary arteries appear unobstructed on angiography but who continue to experience angina. Conducted across five cardiac centers in the Netherlands and Germany (n=153), the investigator-initiated, randomized, blinded-arm controlled trial compared standard care with CFT-guided medical therapy using Philips Doppler FloWire and FloMap systems.
The 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. These results confirm and extend the earlier CorMiCA findings, supporting CFT as a Class I, Level A recommendation in ANOCA patients and demonstrating the potential of Philips Doppler technology to guide individualized treatment strategies safely and effectively. The 12-month results presented on October 26th demonstrate the sustained benefits of CFT-guided care.
iFR and MRI technology
Philips physiology solutions – including its instantaneous wave-free ratio (iFR) pressure wires and software – were used to guide immediate treatment decisions in the trial. Philips also provides advanced cardiac MRI technology, which guided the delayed strategy. By enabling both the invasive and non-invasive approaches evaluated in iMODERN, Philips supported the generation of robust evidence to help guide clinical practice worldwide.
* iFR (instantaneous wave-free ratio) is a minimally invasive way to measure blood pressure through the coronary arteries, helping physicians decide which blockages require stenting.
