title: Pregnancy associated plasma protein A, a novel, quick, and sensitive marker in ST-elevation myocardial infarction.
abstract: 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.
authors.affiliation: The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. kasper.iversen@dadlnet.dk
authors.forename: Kasper K
authors.initials: KK
authors.lastname: Iversen
authors.forename: Ane S
authors.initials: AS
authors.lastname: Teisner
authors.forename: Borge
authors.initials: B
authors.lastname: Teisner
authors.forename: Anette
authors.initials: A
authors.lastname: Kliem
authors.forename: Pia
authors.initials: P
authors.lastname: Thanning
authors.forename: Peer
authors.initials: P
authors.lastname: Grande
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
mesh_terms: D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form; D011266:Pregnancy-Associated Plasma Protein-A