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

Insulin‐Like Growth Factor Binding Protein 4 Fragments Provide Incremental Prognostic Information on Cardiovascular Events in Patients With ST‐Segment Elevation Myocardial Infarction

“…Fourth, treatment of patients with heparin promptly increases circulating PAPP‐A levels, whereas the 2 IGFBP‐4 fragments are not affected. Thus, heparin may displace cell‐surface associated PAPP‐A, but the overall PAPP‐A activity toward IGFBP‐4 appears unaltered . To reaffirm this finding in the present study, PAPP‐A levels were measured in 38 randomly selected patients, and levels were significantly higher in all patients (>20 ng/mL) compared with non–heparin‐treated participants (<2 ng/mL) .…”

“…It has been proposed that the prognostic value might depend on whether patients present with acute or stable disease, and it is intuitive to speculate that IGFBP‐4 fragment levels merely recapitulate infarct size and the acute situation. However, we recently demonstrated that NT‐ and CT‐IGFBP‐4 levels were not altered during the acute phase of a myocardial infarction, and the fragments predicted cardiovascular mortality in type 1 diabetes patients without CVD at baseline during 12 years of follow‐up . These observations suggest that the discrepancies cannot solely be explained by acute versus stable disease or short versus long follow‐up.…”

“…35 Third, the IGFBP-4 fragments display great storage stability. 5,13 Fourth, treatment of patients with heparin promptly increases circulating PAPP-A levels, 4,12 whereas the 2 IGFBP-4 fragments are not affected. Thus, heparin may displace cell-surface associated PAPP-A, but the overall PAPP-A activity toward IGFBP-4 appears unaltered.…”

The IGF system in patients with type 2 diabetes: associations with markers of cardiovascular target organ damage

“…No other antidiabetic treatment was associated with the IGF proteins and outcome. As previous studies have shown strong associations between IGFBP-4 fragment levels and kidney function, the NT-and CT-IGFBP-4 fragment levels were also adjusted for eGFR (21,33,36). Adjustments were made for statin intake in regression analyses including cholesterol levels.…”

“…In all three assays, inter-and intra-assay CVs were less than 15% and 10% respectively. The assays were performed as recently described (33).…”