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.

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.

The study population includes individuals diagnosed with acute ST-segment elevation myocardial infarction (MI), selected by the site personnel according to predefined inclusion criteria. The cohort comprises 1,000 patients, whose baseline clinical characteristics and plasma biomarkers will be assessed.