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

Rhea-AI Summary

Royal Philips (NYSE:PHG) reported late-breaking 3-year results from the iMODERN trial (n=1,146) showing no significant difference in the primary composite endpoint (death, recurrent MI, or heart failure hospitalization) between immediate iFR-guided multivessel treatment during primary PCI and staged CMR-guided treatment within 4 days–6 weeks. Results were published in The New England Journal of Medicine and presented at TCT 2025. Complementary ILIAS ANOCA data (n=153) showed a sustained mean +9.4-point Seattle Angina Questionnaire gain at 6 months with ad-hoc coronary function testing and tailored therapy, with no procedure-related major events.

Positive

• 1,146 patients enrolled across 41 hospitals in 14 countries
• No safety deficit for immediate iFR-guided complete revascularization
• Published in NEJM, supporting global scientific credibility
• ILIAS ANOCA showed +9.4-point SAQ improvement at 6 months

Negative

• No superiority — no significant difference in composite endpoint at 3 years
• ILIAS ANOCA sample size 153, limiting broad generalizability

Insights

Interventional cardiology expert

Three-year randomized data show no major outcome difference between immediate and staged physiology‑guided revascularization.

The trial enrolled 1,146 patients across 41 hospitals and compared immediate iFR‑guided treatment during the index PCI with staged care guided by cardiac MRI, using a composite endpoint of death, reinfarction, or heart‑failure hospitalization at three years. The results found no significant difference in those major outcomes, and the findings were published in The New England Journal of Medicine.

The practical mechanism is simple: extending iFR use to the acute STEMI setting lets operators assess lesion ischemia during the index procedure. The data support that immediate physiology‑guided treatment does not worsen long‑term hard outcomes compared with a staged strategy that uses MRI to select lesions for later treatment.

Key dependencies and risks include operator adherence to physiology protocols, availability of cardiac MRI for the staged arm, and patient selection. The trial reports no excess major adverse events, but the results do not claim superiority for immediate treatment; they establish non‑inferiority in safety for extending physiology assessment to this population.

Watch for guideline updates and professional society statements that may integrate these findings, and for subgroup or procedural detail publications that explain which patients or lesion types benefit most; those items typically appear within months to a year after publication. The NEJM publication and the trial size make the evidence influential for clinical practice, while the absence of a superiority signal suggests practice will shift toward individualized decision making rather than a universal change in timing.

October 29, 2025

• 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 delayed treatment of additional narrowed arteries in heart attack patients to determine whether treating all blockages in one procedure is as safe and effective as waiting for a follow-up procedure. 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.

“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 26^th 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.

For further information, please contact:

Joost Maltha
Philips Global External Relations
Tel.: +31 6 1055816
E-mail: joost.maltha@philips.com

About Royal Philips

Royal Philips (NYSE: PHG, AEX: PHIA) is a leading health technology company focused on improving people’s health and well-being through meaningful innovation. Philips’ patient- and people-centric innovation leverages advanced technology and deep clinical and consumer insights to deliver personal health solutions for consumers and professional health solutions for healthcare providers and their patients in the hospital and the home.

Headquartered in the Netherlands, the company is a leader in diagnostic imaging, ultrasound, image-guided therapy, monitoring and enterprise informatics, as well as in personal health. Philips generated 2024 sales of EUR 18 billion and employs approximately 67,800 employees with sales and services in more than 100 countries. News about Philips can be found at www.philips.com/newscenter.

Attachment

• Philips iFR technology

FAQ

What did Philips announce about the iMODERN 3-year results for PHG on October 29, 2025?

iMODERN (n=1,146) found no significant difference in death, recurrent MI, or heart failure hospitalization at 3 years between immediate iFR-guided PCI and staged CMR-guided treatment.

How does iMODERN affect clinical use of iFR during STEMI for PHG technologies?

The trial supports using iFR-guided immediate treatment as a safe option to complete revascularization during the index procedure when appropriate.

What was the iMODERN trial primary endpoint and follow-up duration reported by PHG?

The primary endpoint was a composite of death, recurrent MI, or heart failure hospitalization with 3-year follow-up.

What did the ILIAS ANOCA findings presented Oct 26, 2025 say about Philips physiology tools?

ILIAS ANOCA (n=153) reported a 9.4-point mean improvement in Seattle Angina Questionnaire at 6 months using ad-hoc coronary function testing and tailored therapy, with no major adverse events.

Were Philips imaging technologies used in both iMODERN strategies?

Yes; Philips iFR pressure wires guided immediate interventions and Philips cardiac MRI guided the staged strategy.