Pregnancy Associated Plasma Protein A, a Novel, Quick, and Sensitive Marker in ST-Elevation Myocardial Infarction

• Published in: The American journal of cardiology 2008-05, Vol.101 (10), p.1389-1394
• Main Authors: Iversen, Kasper K., MD, Teisner, Ane S., MD, Teisner, Borge, MD, Kliem, Anette, Thanning, Pia, MD, Grande, Peer, MD, DMSc, Clemmensen, Peter, MD, DMSc
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical medicine; Coronary Angiography; Coronary heart disease; Creatine Kinase, MB Form - blood; Electrocardiography; Female; Heart; Heart attacks; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - physiopathology; Myocarditis. Cardiomyopathies; Plasma; Predictive Value of Tests; Pregnancy; Pregnancy-Associated Plasma Protein-A - metabolism; Prognosis; Proteins; Retrospective Studies; Severity of Illness Index; Time Factors; Troponin T - blood
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.01.015

Traditional biomarkers in acute coronary syndromes reflect myocardial necrosis but not the underlying arteriosclerotic disease. Pregnancy-associated plasma protein A (PAPP-A) is a new biomarker in acute coronary syndromes that detects vulnerable plaques in arteriosclerotic disease and identifies acute coronary syndromes earlier than traditionally used biomarkers. Information regarding circulating PAPP-A levels in patients with ST elevation myocardial infarctions (STEMIs) is limited and contradictory. The aim of the present study was to describe the presence and time-related pattern of circulating PAPP-A levels in patients with STEMIs. Consecutive patients (n = 354) referred for primary percutaneous intervention because of STEMI were included in the study. Blood samples for the analysis of PAPP-A, creatine kinase-MB (CKMB), and troponin T were drawn at admission and every 6 to 8 hours until biomarkers of myocardial necrosis were consistently decreasing. PAPP-A was measured using a newly developed sandwich enzyme-linked immunosorbent assay technique based on 2 monoclonal antibodies. In total, 1,091 PAPP-A, 1,049 troponin T, and 1,016 CKMB samples were analyzed. Mean PAPP-A values at admission were significantly higher in patients with STEMIs than in those with non–ST elevation myocardial infarctions or unstable angina pectoris (27.6 vs 12.2 mIU/L, p