Pregnancy-associated plasma protein A: a biomarker in acute ST-elevation myocardial infarction (STEMI)
Juha Lund1, Qiu-Ping Qin, Tuomo Ilva
1Department of Medicine, University of Turku, Finland. juha.lund@tyks.fi
Insights
Pregnancy-associated plasma protein A (PAPP-A) levels rise early after ST-elevation myocardial infarction (STEMI) and decline rapidly. Elevated PAPP-A indicates increased cardiovascular risk and can reflect reperfusion success in STEMI patients.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- Pregnancy-associated plasma protein A (PAPP-A) is a marker of plaque instability linked to cardiac events in acute coronary syndromes (ACS).
- Limited data exists on PAPP-A kinetics and clinical significance post-plaque rupture in ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To assess the 48-hour release pattern of PAPP-A in STEMI patients.
- To determine the association between PAPP-A levels and 12-month outcomes following STEMI.
Main Methods:
- Sixty-two STEMI patients (40 male, 22 female, median age 67.5) were enrolled, with 87.1% receiving reperfusion therapy.
- PAPP-A levels were measured at baseline and at 6-12, 24, and 48 hours post-admission; additional early samples were taken in 14 patients.
- Correlations between PAPP-A, C-reactive protein, and cardiac troponin I were examined.
Main Results:
- An initial surge in PAPP-A was observed within 12 hours of symptom onset, followed by a swift decline.
- A secondary, late elevation in PAPP-A occurred in 32.3% of patients.
- Higher admission PAPP-A (>10.0 mIU/L) correlated with increased 12-month risk of cardiovascular death or non-fatal myocardial infarction (P=0.049).
- The combination of failed early reperfusion and late PAPP-A elevation strongly predicted adverse outcomes (P=0.016).
Conclusions:
- PAPP-A exhibits early elevation and rapid decline in STEMI, suggesting release from ruptured plaques.
- PAPP-A kinetics variability at 48 hours may indicate reperfusion success.
- PAPP-A demonstrates potential prognostic value in STEMI patients.
Background:
Elevated circulating levels of pregnancy-associated plasma protein A (PAPP-A), a novel marker of atherosclerotic plaque instability, are associated with increased risk of future cardiac events in patients with acute coronary syndromes (ACS). However, little is known of the kinetics or clinical significance of circulating PAPP-A after plaque rupture in acute ST-elevation myocardial infarction (STEMI).
Aim:
To evaluate the 48-hour release of pregnancy-associated plasma protein A (PAPP-A) and its association with 12-month outcome in patients with acute ST-elevation myocardial infarction (STEMI).
Methods:
Sixty-two consecutive STEMI patients were included (40 men and 22 women, median age 67.5 years (range 34-84)), of whom 54 (87.1%) received reperfusion therapy. PAPP-A was measured at admission and 6-12, 24 and 48 hours thereafter. In 14 patients, samples were obtained also at 1, 2 and 4 hours.
Results:
There was an early peak of circulating PAPP-A during the first 12 hours from symptom onset, followed by rapid normalization. A second, late PAPP-A elevation was noticed in 20/62 patients (32.3%). Admission PAPP-A >10.0 mIU/L (highest tertile) was associated (P = 0.049) with increased 12-month risk of cardiovascular death or non-fatal myocardial infarction. Moreover, the combination of failed early reperfusion together with late PAPP-A elevation was strongly (7/13 versus 10/49 patients, P = 0.016) associated with adverse outcome. Admission PAPP-A did not correlate with admission C-reactive protein or cardiac troponin I.
Conclusions:
PAPP-A is elevated early in STEMI and then declines rapidly, a pattern consistent with release from the ruptured plaque. The variability of PAPP-A kinetics at 48 hours reflects the success of reperfusion. This study also shows that PAPP-A may have prognostic value in STEMI.
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