PAPP-A and IGFBP-4 fragment levels in patients with ST-elevation myocardial infarction treated with heparin and PCI

Rikke Hjortebjerg, Søren Lindberg, Jan S Jensen, Claus Oxvig, Mette Bjerre, Jan Frystyk

Research output: Contribution to journalJournal articleResearchpeer-review


OBJECTIVES: Circulating levels of pregnancy-associated plasma protein-A (PAPP-A) predict outcome in patients with acute coronary syndrome (ACS). Unfortunately, administration of heparin to patients with ACS increases circulating PAPP-A, probably by a detachment of PAPP-A from cell surfaces, inducing a considerable bias when using PAPP-A as a biomarker. It remains unknown whether PAPP-A-derived N- and C-terminal fragments of insulin-like growth factor binding protein-4 (NT-IGFBP-4/CT-IGFBP-4) are acutely affected by the increase in PAPP-A.

METHODS: We prospectively included 78 patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI). Prior to PCI, patients were injected with 10,000IU of unfractionated heparin (UFH). Blood samples were collected immediately before PCI, but after UFH-injection, immediately after PCI and on day 1 and day 2. Plasma IGFBP-4, CT-IGFBP-4 and NT-IGFBP-4 levels were determined by specific, novel immunoassays, and PAPP-A and IGF-I by commercial immunoassays.

RESULTS: Plasma PAPP-A was strongly elevated upon STEMI, UFH-administration and PCI with mean concentrations (95%-confidence interval) pre-PCI, post-PCI, day 1, and day 2 of 13.0 (11.2;15.2), 14.8 (13.1;16.8), 1.03 (0.90;1.18), and 1.08 (0.92;1.28) μg/l, respectively (p<0.0001). Pre-PCI concentrations of IGFBP-4, CT-IGFBP-4 and NT-IGFBP-4 were 154 (142;166), 53 (47;60) and 136 (122;150) μg/l, and levels were unaltered post-PCI. Concentrations increased on day 1 by 63 (43;87)%, 69 (36;110)%, and 47 (21;79)%, respectively (p<0.0001), i.e. at a time point when PAPP-A levels had normalized.

CONCLUSION: Plasma IGFBP-4-fragment levels are not acutely altered in patients with STEMI treated with UFH and PCI. Thus, they possess potentials as prognostic markers in ACS patients.

Original languageEnglish
JournalClinical Biochemistry
Issue number4-5
Pages (from-to)322-328
Number of pages7
Publication statusPublished - Mar 2015


  • Acute coronary syndrome (ACS)
  • Biomarker
  • Cardiovascular disease
  • Heparin
  • IGF binding protein-4 (IGFBP-4)
  • IGFBP-4 fragment
  • Insulin-like growth factor (IGF)
  • Pregnancy-associated plasma protein-A (PAPP-A)
  • ST-segment elevation myocardial infarction (STEMI)
  • Prospective Studies
  • Percutaneous Coronary Intervention/trends
  • Humans
  • Middle Aged
  • Male
  • Treatment Outcome
  • Anticoagulants/therapeutic use
  • Insulin-Like Growth Factor Binding Protein 4/blood
  • Myocardial Infarction/blood
  • Pregnancy-Associated Plasma Protein-A/metabolism
  • Biomarkers/blood
  • Female
  • Heparin/therapeutic use
  • Aged


Dive into the research topics of 'PAPP-A and IGFBP-4 fragment levels in patients with ST-elevation myocardial infarction treated with heparin and PCI'. Together they form a unique fingerprint.

Cite this