Prediction of LVAR and MACE in STEMI Though Plasma Multiomics Analysis

Summary

To identify plasma multi-omics biomarkers that predict left ventricular adverse remodeling (LVAR) and major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction, and to investigate the molecular pathways linked to LVAR and MACE.

Eligibility

Inclusion Criteria:

1. Age ≥18 years and ≤80 years.
2. Definite diagnosis of STEMI according to ESC/ACC guidelines:

   * Chest pain lasting \>30 minutes, and
   * ST-segment elevation in at least two contiguous leads: ≥0.2 mV in leads V2-V3 (≥0.2 mV for men, ≥0.15 mV for women) or ≥0.1 mV in other leads, or new-onset left bundle branch block.
3. Reperfusion therapy: Symptom onset to first medical contact ≤12 hours, and successful primary PCI (culprit vessel opened, post-procedure TIMI flow grade 3).
4. First STEMI (no prior history of myocardial infarction).
5. Left ventricular ejection fraction (by echocardiography within 24-48 hours after admission) ≥35%.
6. Informed consent: Signed informed consent obtained, with willingness to undergo serial blood sampling and echocardiographic follow-up.

Exclusion Criteria:

1. Non-atherosclerotic MI: coronary embolism, spasm, aortic dissection, myocarditis, Takotsubo.
2. Severe comorbidities:

   * Prior HF (NYHA ≥II);
   * Severe CKD (eGFR \<30 mL/min/1.73m² or dialysis);
   * Severe liver disease (Child-Pugh B/C);
   * Active malignancy (life expectancy \<1 year);
   * Severe hematologic disorders (thrombocytopenia, coagulopathy, active bleeding).
3. Fibrinolysis-followed-by-PCI.
4. Primary PCI complications:

   * No-reflow/slow-flow (final TIMI \<2);
   * Cardiogenic shock or mechanical complication within 7 days;
   * In-hospital repeat revascularization.
5. Inability to complete 6-month follow-up.
6. Factors affecting blood sampling/exosome/immune/proteome assays:

   * Blood transfusion within 1 month;
   * Known hemolytic disorder;
   * Inadequate venous access.
7. Pregnancy or lactation.

Conditions6

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