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.
Description
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.
Eligibility
Inclusion Criteria:
- Age ≥18 years and ≤80 years.
- 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.
- Reperfusion therapy: Symptom onset to first medical contact ≤12 hours, and successful primary PCI (culprit vessel opened, post-procedure TIMI flow grade 3).
- First STEMI (no prior history of myocardial infarction).
- Left ventricular ejection fraction (by echocardiography within 24-48 hours after admission) ≥35%.
- Informed consent: Signed informed consent obtained, with willingness to undergo serial blood sampling and echocardiographic follow-up.
Exclusion Criteria:
- Non-atherosclerotic MI: coronary embolism, spasm, aortic dissection, myocarditis, Takotsubo.
- 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).
- Fibrinolysis-followed-by-PCI.
- Primary PCI complications:
- No-reflow/slow-flow (final TIMI \<2);
- Cardiogenic shock or mechanical complication within 7 days;
- In-hospital repeat revascularization.
- Inability to complete 6-month follow-up.
- Factors affecting blood sampling/exosome/immune/proteome assays:
- Blood transfusion within 1 month;
- Known hemolytic disorder;
- Inadequate venous access.
- Pregnancy or lactation.
