Pregnancy-associated plasma protein A: A biomarker in acute ST-elevation myocardial infarction (STEMI)

被引:73
作者
Lund, J [1 ]
Qin, QP
Ilva, T
Nikus, K
Eskola, M
Porela, P
Kokkala, S
Pulkki, K
Pettersson, K
Voipio-Pulkki, LM
机构
[1] Univ Turku, Dept Med, FIN-20520 Turku, Finland
[2] Univ Turku, Dept Biotechnol, FIN-20520 Turku, Finland
[3] Tampere Univ Hosp, Ctr Heart, Tampere, Finland
[4] Univ Helsinki, Dept Clin Chem, Helsinki, Finland
[5] Univ Helsinki, Cent Hosp, Dept Med, Helsinki, Finland
关键词
pregnancy-associated plasma protein A; STEMI; prognosis;
D O I
10.1080/07853890500525883
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
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 12month 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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收藏
页码:221 / 228
页数:8
相关论文
共 11 条
[1]
Pregnancy-associated plasma protein a as a marker of acute coronary syndromes [J].
Bayes-Genis, A ;
Conover, CA ;
Overgaard, MT ;
Bailey, KR ;
Christiansen, M ;
Holmes, DR ;
Virmani, R ;
Oxvig, C ;
Schwartz, RS .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 345 (14) :1022-1029
[2]
Admission Troponin T and measurement of ST-segment resolution at 60 min improve early risk stratification in ST-elevation myocardial infarction [J].
Björklund, E ;
Lindahl, B ;
Johanson, P ;
Jernberg, T ;
Svensson, AM ;
Venge, P ;
Wallentin, L ;
Dellborg, M .
EUROPEAN HEART JOURNAL, 2004, 25 (02) :113-120
[3]
Mutational analysis of the proteolytic domain of pregnancy-associated plasma protein-A (PAPP-A): classification as a metzincin [J].
Boldt, HB ;
Overgaard, MT ;
Laursen, LS ;
Weyer, K ;
Sottrup-Jensen, L ;
Oxvig, C .
BIOCHEMICAL JOURNAL, 2001, 358 (02) :359-367
[4]
Pregnancy-associated plasma protein A and its endogenous inhibitor, the proform of eosinophil major basic protein (proMBP), are related to complex stenosis morphology in patients with stable angina pectoris [J].
Cosin-Sales, J ;
Christiansen, M ;
Kaminski, P ;
Oxvig, C ;
Overgaard, MT ;
Cole, D ;
Holt, DW ;
Kaski, JC .
CIRCULATION, 2004, 109 (14) :1724-1728
[5]
Pregancy-associated plasma protein-a levels in patients with acute coronary syndromes - Comparison with markers of systemic inflammation, platelet activation, and myocardial necrosis [J].
Heeschen, C ;
Dimmeler, S ;
Hamm, CW ;
Fichtscherer, S ;
Simoons, ML ;
Zeiher, AM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2005, 45 (02) :229-237
[6]
Evaluation of pregnancy-associated plasma protein A as a prognostic indicator in acute coronary syndrome patients [J].
Laterza, OF ;
Cameron, SJ ;
Chappell, D ;
Sokoll, LJ ;
Green, GB .
CLINICA CHIMICA ACTA, 2004, 348 (1-2) :163-169
[7]
Circulating pregnancy-associated plasma protein A predicts outcome in patients with acute coronary syndrome but no troponin I elevation [J].
Lund, J ;
Qin, QP ;
Ilva, T ;
Pettersson, K ;
Voipio-Pulkki, LM ;
Porela, P ;
Pulkki, K .
CIRCULATION, 2003, 108 (16) :1924-1926
[8]
Molecular distinction of circulating pregnancy-associated plasma protein A in myocardial infarction and pregnancy [J].
Qin, QP ;
Kokkala, S ;
Lund, J ;
Tamm, N ;
Voipio-Pulkki, LM ;
Pettersson, K .
CLINICAL CHEMISTRY, 2005, 51 (01) :75-83
[9]
Qin QP, 2002, CLIN CHEM, V48, P473
[10]
Release patterns of pregnancy associated plasma protein A (PAPP-A) in patients with acute coronary syndromes [J].
Qin, QP ;
Laitinen, P ;
Majamaa-Voltti, K ;
Eriksson, S ;
Kumpula, EK ;
Pettersson, K .
SCANDINAVIAN CARDIOVASCULAR JOURNAL, 2002, 36 (06) :358-361