Lund Juha, Qin Qiu-Ping, Ilva Tuomo, Nikus Kjell, Eskola Markku, Porela Pekka, Kokkala Saara, Pulkki Kari, Pettersson Kim, Voipio-Pulkki Liisa-Maria
Department of Medicine, University of Turku, Finland.
Ann Med. 2006;38(3):221-8. doi: 10.1080/07853890500525883.
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).
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).
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.
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.
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.
妊娠相关血浆蛋白A（PAPP-A）是动脉粥样硬化斑块不稳定的一种新标志物，其循环水平升高与急性冠状动脉综合征（ACS）患者未来发生心脏事件的风险增加相关。然而，对于急性ST段抬高型心肌梗死（STEMI）斑块破裂后循环PAPP-A的动力学或临床意义知之甚少。
评估急性ST段抬高型心肌梗死（STEMI）患者妊娠相关血浆蛋白A（PAPP-A）的48小时释放情况及其与12个月预后的关系。
纳入62例连续的STEMI患者（40例男性和22例女性，中位年龄67.5岁（范围34-84岁）），其中54例（87.1%）接受了再灌注治疗。入院时及此后6-12、24和48小时测量PAPP-A。14例患者在1、2和4小时也采集了样本。
从症状发作开始的前12小时内循环PAPP-A出现早期峰值，随后迅速恢复正常。20/62例患者（32.3%）出现第二次、晚期PAPP-A升高。入院时PAPP-A>10.0 mIU/L（最高三分位数）与12个月心血管死亡或非致命性心肌梗死风险增加相关（P = 0.049）。此外，早期再灌注失败与晚期PAPP-A升高共同出现与不良结局密切相关（7/13例患者与10/49例患者，P = 0.016）。入院时PAPP-A与入院时C反应蛋白或心肌肌钙蛋白I无相关性。
STEMI患者早期PAPP-A升高，随后迅速下降，这一模式与破裂斑块的释放一致。PAPP-A在48小时的动力学变异性反映了再灌注的成功。本研究还表明，PAPP-A在STEMI中可能具有预后价值。
