Can a diabetes drug shield the heart during a heart attack procedure?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Age 18-75 years at presentation. * South Asian ethnicity (Pakistani, Indian, Bangladeshi, Sri Lankan, or Nepali origin). * First STEMI: ST-elevation ≥1 mm in ≥2 contiguous limb leads, or ≥2 mm in ≥2 contiguous precordial leads, or new LBBB with consistent presentation. * Symptom onset to hospital arrival ≤12 hours. * Scheduled for primary PCI with intent to perform balloon inflation and stenting. * eGFR ≥45 mL/min/1.73m² (CKD-EPI) from point-of-care creatinine at presentation. * Able to take oral medication (or crushed tablet with water), swallowing ability confirmed by treating nurse. * Written informed consent from patient or legally authorised representative Exclusion Criteria: * Cardiogenic shock at presentation (Killip IV: SBP \<90 mmHg despite volume, requiring vasopressors, IABP, or mechanical circulatory support). * Type 1 diabetes mellitus. * SGLT2 inhibitor use within 3 months of presentation. * Active urinary tract infection or genital mycotic infection. * eGFR \<45 mL/min/1.73m² at presentation. * Severe hepatic impairment (Child-Pugh Class C). * Known hypersensitivity to empagliflozin or any SGLT2 inhibitor. * History of diabetic ketoacidosis (euglycaemic or classical) at any time. * Pregnancy, breastfeeding, or refusal of contraception (women of childbearing potential). * Prior myocardial infarction or prior coronary revascularisation. * Left main culprit artery as the infarct-related vessel. * Rescue PCI after fibrinolysis in the current presentation. * Severe multivessel disease with anticipated need for urgent CABG within 48 hours. * Cardiac arrest with coma (GCS \<8) at presentation consent not obtainable and metabolic state unpredictable. * Significant metabolic abnormality precluding oral drug: severe vomiting, nil-by-mouth status, or frank dehydration with SBP \<100 mmHg on arrival. * Concurrent participation in another interventional clinical trial. * Life expectancy \<6 months from a non-cardiac cause. * Expected inability to attend the 90-day follow-up visit.