Prediction of LVAR and MACE in STEMI Though Plasma Multiomics Analysis

Beijing Anzhen Hospital1,000 enrolled

Overview

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.

Despite advances in AMI treatment, a substantial proportion of patients develop LVAR, leading to heart failure and increased MACE risk. Conventional biomarkers (e.g., troponin, NT-proBNP) lack sufficient predictive power for adverse outcomes. Multi-omics approaches - integrating proteomics(e.g., exosome proteomics), metabolomics, transcriptomics ,lipidomics and Immunomics- offer a systems-level view that may uncover novel prognostic signatures. Prospective blood sampling was performed in a cohort of first-STEMI patients treated with primary PCI. After 6-month follow-up, patients with left ventricular adverse remodeling (cases) were matched with non-remodeling controls (nested case-control design) for multi-omics analysis (exosome, immune, proteome) using the pre-collected serial blood samples.

Study Type

OBSERVATIONAL

Enrollment

1,000

Conditions

Left Ventricular Remodeling Plasma Multi-Omics Acute ST-segment Elevation Myocardial Infarction Immunomics Major Adverse Cardiovascular Events

Interventions

Diagnostic Test: echocardiography and blood collectionOTHER

Blood samples were collected from all patients at enrollment (within 24 hours after primary PCI), at days 3-5, and at months 1, 3, and 6 after enrollment. Echocardiography was performed at enrollment (baseline, within 24-48 hours after admission), and at months 1, 3, and 6 after enrollment.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

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.

Outcomes

Primary Outcomes

major adverse cardiovascular events

Identify T0 plasma multi-omics biomarkers that predict cardiac death, myocardial infarction, heart failure, and stroke.

Time frame: From enrollment to 36 months.

Secondary Outcomes

adverse cardiac remodeling

To assess the predictive ability of multi-omics biomarkers in T0 plasma for adverse cardiac remodeling, and to identify new candidate markers for forecasting this condition.

Time frame: From enrollment to 6 months