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

https://doi.org/10.1016/j.amjcard.2008.01.015Get rights and content

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 <0.01). In samples drawn <2 hours after admission, the sensitivity of PAPP-A was superior (93%) to that of CKMB (60%) and troponin T (61%). In conclusion, PAPP-A levels are elevated in >90% of patients presenting with STEMIs if measured <6 hours after the onset of symptoms or <2 hours of primary percutaneous coronary intervention. In the early stages of STEMI, PAPP-A seems to be a more sensitive marker of myocardial infarction than CKMB and troponin T.

Section snippets

Methods and Results

All patients referred to Rigshospitalet in Copenhagen, Denmark, from April 1, 2005, to December 31, 2005, for primary percutaneous intervention (pPCI) due to STEMI were included in the study. Guidelines for referral for pPCI due to STEMI were adapted from the Danish Trial in Acute Myocardial Infarction (DANAMI) 2 study: significant ST elevation (>1 mm in leads I, II, III, aVL, and aVF or >2 mm in leads V1 to V6) in ≥2 contiguous leads or newly developed left-bundle branch block and symptom

Discussion

This study shows that PAPP-A is elevated in >90% of patients presenting with STEMIs if measured <6 hours after the onset of symptoms or <2 hours after pPCI.

In the early stages of STEMI, PAPP-A is a more sensitive and earlier marker of myocardial infarction than CKMB and troponin T.

Circulating PAPP-A levels were originally measured by a competitive radioimmunoassay,20 but all recently published studies are based on ELISA techniques. Many assays for measuring PAPP-A are currently available,

References (20)

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