SYSTEMI - systemic organ communication in STEMI: design and rationale of a cohort study of patients with ST-segment
Florian Bönner1, Christian Jung1, Amin Polzin1
1Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
Insights
This study investigates how heart and body metabolism interact in ST-segment elevation myocardial infarction (STEMI) patients. Identifying metabolic patterns may improve risk assessment and personalized treatments for heart attack survivors.
Area of Science:
- Cardiology
- Metabolic Research
- Biomedical Engineering
Background:
- ST-segment elevation myocardial infarction (STEMI) remains a leading cause of death and disability despite advanced treatments.
- Risk stratification for major adverse cardiovascular and cerebral events (MACCE) and heart failure re-hospitalization in STEMI patients is challenging.
- The interplay between myocardial and systemic metabolic dysfunction in STEMI is not fully understood.
Purpose of the Study:
- To systematically phenotype cardiocirculatory and metabolic status in STEMI patients.
- To assess the bidirectional interaction between cardiac and systemic metabolism following STEMI.
- To identify metabolic "master switches" influencing patient outcomes.
Main Methods:
- The Systemic Organ Communication in STEMI (SYSTEMI) study is a prospective, open-end trial.
- Patients undergo serial data collection at baseline, 24 hours, 5 days, 6 months, and 12 months post-STEMI.
- Multilayered data acquisition includes cardiac imaging, multi-nuclei magnetic resonance spectroscopy, liquid biopsies for systemic metabolism analysis (glucose, lipids, oxygen transport), and genomic/transcriptomic information.
Main Results:
- Primary endpoints include myocardial function, left ventricular remodeling, myocardial texture, and coronary patency at 6 months.
- Secondary endpoints encompass all-cause death, MACCE, and re-hospitalization for heart failure or revascularization at 12 months.
- The study aims to identify novel metabolic patterns and key regulators in STEMI.
Conclusions:
- The SYSTEMI study will provide comprehensive insights into cardiac and systemic metabolism in STEMI.
- Findings are expected to enhance diagnostic and therapeutic strategies for myocardial ischemia.
- Improved patient risk assessment and tailored therapies are anticipated outcomes.
Background:
ST-segment elevation myocardial infarction (STEMI) still causes significant mortality and morbidity despite best-practice revascularization and adjunct medical strategies. Within the STEMI population, there is a spectrum of higher and lower risk patients with respect to major adverse cardiovascular and cerebral events (MACCE) or re-hospitalization due to heart failure. Myocardial and systemic metabolic disorders modulate patient risk in STEMI. Systematic cardiocirculatory and metabolic phenotyping to assess the bidirectional interaction of cardiac and systemic metabolism in myocardial ischemia is lacking.
Methods:
Systemic organ communication in STEMI (SYSTEMI) is an all-comer open-end prospective study in STEMI patients > 18 years of age to assess the interaction of cardiac and systemic metabolism in STEMI by systematically collecting data on a regional and systemic level. Primary endpoint will be myocardial function, left ventricular remodelling, myocardial texture and coronary patency at 6 month after STEMI. Secondary endpoint will be all-cause death, MACCE, and re-hospitalisation due to heart failure or revascularisation assessed 12 month after STEMI. The objective of SYSTEMI is to identify metabolic systemic and myocardial master switches that determine primary and secondary endpoints. In SYSTEMI 150-200 patients are expected to be recruited per year. Patient data will be collected at the index event, within 24 h, 5 days as well as 6 and 12 months after STEMI. Data acquisition will be performed in multilayer approaches. Myocardial function will be assessed by using serial cardiac imaging with cineventriculography, echocardiography and cardiovascular magnetic resonance. Myocardial metabolism will be analysed by multi-nuclei magnetic resonance spectroscopy. Systemic metabolism will be approached by serial liquid biopsies and analysed with respect to glucose and lipid metabolism as well as oxygen transport. In summary, SYSTEMI enables a comprehensive data analysis on the levels of organ structure and function alongside hemodynamic, genomic and transcriptomic information to assess cardiac and systemic metabolism.
Discussion:
SYSTEMI aims to identify novel metabolic patterns and master-switches in the interaction of cardiac and systemic metabolism to improve diagnostic and therapeutic algorithms in myocardial ischemia for patient-risk assessment and tailored therapy.
Trial Registration:
Trial Registration Number: NCT03539133.
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