Cardiometabolic traits at hospital admission impact on outcome in STEMI: insights from the prospective SYSTEMI Trial in completely revascularized patients

Outcomes after ST-elevation myocardial infarction (STEMI) differ between randomized controlled trials (RCTs) and real-world registries despite guideline-directed care. The cardiometabolic profiles of these populations remain incompletely illustrated. We aimed to characterize contemporary STEMI patients using detailed prospectively collected metabolic, renal, and inflammatory phenotyping data from the SYSTEMI study and to compare these with contemporary STEMI RCT and registry cohorts. Among 833 SYSTEMI patients (74% male; mean age 64 years), 24.5% presented with cardiogenic shock and 23.4% with out-of-hospital cardiac arrest (OHCA). Cardiovascular (CV) risk factors and CV disease (CVD) history included smoking (41%), arterial hypertension (60%), chronic kidney disease (CKD III-V 21%), prior myocardial infarction (11%), prior stroke (4%), peripheral arterial disease (8%). Dysglycemia was common (27% type 2 diabetes, 24% prediabetes) and was accompanied by higher C-reactive protein levels (CPR) in patients with type 2 diabetes. Among 25 RCTs (30,646 patients) and 43 registries (1,332,993 patients) from the complete-revascularization era, RCT cohorts were consistently younger, less comorbid, and reported lower in-hospital mortality than registries. SYSTEMI, characterizing cardiometabolic traits in contemporary STEMI patients, most closely resembled European and North American registries in demographics and CVD burden. Within SYSTEMI, CKD, admission CRP, and admission glucose were associated with in-hospital mortality after multivariable adjustment.