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

Figures & data

Table I. Baseline characteristic of the whole and the frequent sampling group (A) and according to admPAPP‐A levels (B).

	A:		B:
	Whole group	Frequent sampling	Admission PAPP‐A (mIU/L)
	n = 62	n = 14	<3.0	3.0–10.0	>10.0	P^a
			n = 20	n = 20	n = 22
Age ^b	67.5 (34–84)	62.5 (46–81)	62.5 (34–84)	66.0 (44–82)	71.5 (51–83)	0.045
Male gender (%)	40 (64.5)	10 (71.4)	10 (50.0)	17 (85.0)	13 (59.0)	ns
BMI ^b	27.1 (17.3–34.9)	27.8 (21.6–34.9)	26.9 (17.3–34.9)	27.8 (21.6–32.7)	26.9 (21.2–34.6)	ns
ST‐elevation on ECG
Anterior (%)	21 (33.9)	6 (42.9)	5 (25.0)	5 (25.0)	11 (50.0)	0.046
Inferior (%)	28 (45.2)	6 (42.9)	8 (40.0)	12 (60.0)	8 (36.0)	ns
Postero‐lateral (%)	13 (21.0)	2 (14.3)	7 (35)	3 (15)	3 (13.6)	ns
Thrombolysis (%)	51 (82.3)	14 (100.0)	14 (70.0)	15 (75.0)	22 (100)	0.007
Delay (min) from symptom onset to reperfusion therapy ^c	150 [90, 300]	285 [90, 360]	180 [120, 400]	120 [60, 360]	160 [90, 270]	ns
Early reperfusion on ECG (%)	43 (69.4)	11 (78.6)	17 (85.0)	12 (60.0)	14 (63.6)	ns
Revascularization (PCI or CABG) (%) ^d	27 (43.5)	7 (50.0)	7 (35.0)	10 (50.0)	10 (45.0)	ns
Current smoking (%)	20 (32.3)	5 (35.7)	9 (45.0)	5 (25.0)	6 (27.3)	ns
Hypertension (%)	21 (33.9)	4 (28.6)	7 (35.0)	7 (35.0)	7 (31.8)	ns
Previous MI (%)	10 (16.1)	1 (7.1)	1 (5.0)	3 (15.0)	6 (27.3)	0.076
Diabetes mellitus (%)	7 (11.3)	2 (14.3)	1 (5.0)	1 (5.0)	5 (22.7)	0.035
Killip class ⩾2 (%) ^e	30 (48.4)	4 (28.6)	8 (40.0)	9 (45.0)	13 (59.1)	ns
Family history of CVD (%)	25 (40.3)	5 (35.7)	5 (25.0)	11 (55.0)	9 (40.9)	ns
AdmcTnI ng/mL ^c	0.2 [0, 0.4]	0.3 [0, 1.3]	0 [0, 0.3]	0.2 [0, 0.7]	0.25 [0, 2.0]	ns
48 hours cTnI ng/mL ^c	7.9 [2.9, 16.4]	6.7 [3.7, 11.8]	7.4 [3.6, 16.4]	11.1 [2.9, 17.3]	5.9 [2.0, 13.2]	ns
MaxTnI ng/mL ^c	28.8 [13.1, 109.4]	51.5 [17.0, 115.8]	33.9 [11.9, 153.8]	34,2 [11.0, 89.8]	27.9 [13,2, 109.4]	ns
AdmCRP mg/L ^c	2.1 [1.0, 5.2]	2.6 [1.0, 5.7]	2.3 [0.75, 4.35]	2.1 [1.0, 5.1]	2.7 [1.6, 5.7]	ns

^aP‐value for difference between the groups with admPAPP‐A > and <10.0 mIU/L. ^b Median (range). ^c Median [25th, 75th]. ^d During 1‐year follow‐up. ^e Killip class during index hospitalization. BMI = body mass index; ECG = electrocardiogram; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft; MI = myocardial infarction; CVD = cardiovascular disease; AdmcTnI = admission cardiac troponin I; MaxcTnI = maximal cardiac troponin I; AdmCRP = admission C‐reactive protein; ns = non‐significant.

Figure 1. (A) The averaged (median 10th, 25th, 50th, 75th, 90th percentile) release pattern of PAPP‐A and cTnI of the 14 patients with frequent early blood sampling (box plots). X‐axis: Time after admission (hours). The bolded dotted line represents the upper 97.5th PAPP‐A percentile in healthy normal males (see Discussion). (B) Median release patterns of PAPP‐A during the first 12 hours in the frequent sampling group according to delay from symptom onset to thrombolysis. Solid line: short delay (<285 min), dotted line: long delay (>285 min). X‐axis: time after admission (hours).

Table II. Baseline characteristics of all patients according to the late PAPP‐A elevation status.

	Late PAPP‐A elevation
	Yes n = 20	No n = 42	P^a
Age ^b	70.5 (34, 84)	64 (37, 83)	0.038
Male gender (%)	14 (73.6)	26 (62.0)	ns
ST‐elevation on ECG
Anterior (%)	11 (55.0)	11 (26.2)	0.028
Inferior (%)	4 (21.0)	23 (54.8)	0.016
Postero‐lateral (%)	4 (21.0)	9 (21.4)	ns
Thrombolysis (%)	15 (75.0)	36 (86.0)	ns
Delay (min) from symptom onset to reperfusion therapy ^c	180 [90, 300]	175 [120, 422]	ns
Early reperfusion on ECG (%)	7 (35.0)	37 (88.1)	<0.001
Revascularization (PCI or CABG) (%) ^d	8 (40.0)	19 (42.0)	ns
Previous MI (%)	2 (10.0)	8 (19.0)	ns
Diabetes mellitus (%)	0 (0)	7 (16.7)	ns
Killip ⩾2 (%)^e	12 (60.0)	18 (42.9)	ns
AdmcTnI ng/mL ^c	0.2 [0, 1.35]	0.1 [0, 0.4]	ns
48 hours cTnI ng/mL ^c,f	11.1 [4.0, 17.9]	6.1 [2.8, 16.0]	ns
MaxcTnI ng/mL ^c	34.0 [15.3, 204.7]	28.8 [9.6, 99.8]	ns
AdmCRP mg/L ^c	1.55 [0.95, 3.6]	2.65 [1.25, 6.0]	ns

^aP‐value for difference. ^b Median (range). ^c Median [25th, 75th]. ^d During 1‐year follow‐up. ^e Killip class during index hospitalization. ^f Taken at 48 hours after admission. ECG = electrocardiogram; PCI = percutaneous coronary intervention; CABG = coronary artery bypass graft; MI = myocardial infarction; AdmcTnI = admission cardiac troponin I; MaxcTnI = maximal cardiac troponin I; AdmCRP = admission C‐reactive protein; ns = non‐significant.

Figure 2. Kaplan‐Maier analysis of the 12‐month outcome (cardiovascular mortality and non‐fatal MI) according to admPAPP‐A tertiles. X‐axis: days after admission of index hospitalization.