The effect of primary percutaneous coronary intervention as compared to tenecteplase on myeloperoxidase, pregnancy-associated plasma protein A, soluble fibrin and D-dimer in acute myocardial infarction.
BACKGROUND
Acute coronary reperfusion is accomplished pharmacologically with intravenous thrombolytic therapy or mechanically with primary percutaneous coronary intervention (PCI).


METHODS
We have determined the immediate effects of the main coronary reperfusion procedures on the plasma concentrations of myeloperoxidase (MPO), pregnancy-associated plasma protein A (PAPP-A), fibrin monomer (FM) and D-dimer (DD). We studied a total of 38 patients admitted for ST-segment elevation infarct (STEMI). 18 patients were given thrombolytic therapy with tenecteplase and 20 were treated with primary PCI.


RESULTS
The plasma concentrations of PAPP-A increased by a factor of six to eight times (p<0.001) following both reperfusion therapies. No significant increase was observed for MPO by either procedure. DD and FM concentrations both increased significantly following thrombolytic therapy, p=0.000, whereas only minor increases, although statistically significant for FM (p=0.013), were noted after PCI. DD and FM were highly correlated prior to the two treatment regimens (R=0.91), and were still highly correlated after PCI (R=0.94) and thrombolytic therapy (R=0.86). No correlation was demonstrated between PAPP-A and markers of activated coagulation.


CONCLUSIONS
This is the first report of a significant rise in the plasma concentration of PAPP-A after PCI as compared to thrombolytic treatment (p=0.002) and may indicate a greater impact of PCI than that of thrombolytic therapy on target coronary plaques.
Brügger-Andersen
Trygve
T
Institute of Medicine, University of Bergen, Stavanger University Hospital, Stavanger, Norway. hagerman@online.no
Hetland
Øyvind
Ø
Pönitz
Volker
V
Grundt
Heidi
H
Nilsen
Dennis W T
DW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005337:Fibrin / Q000032:analysis*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy*; D009195:Peroxidase / Q000097:blood; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D012995:Solubility; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D017984:Enoxaparin; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D; D005337:Fibrin; D009195:Peroxidase; D010959:Tissue Plasminogen Activator; D011266:Pregnancy-Associated Plasma Protein-A; D000077785:Tenecteplase