The effect of primary percutaneous coronary intervention as compared to tenecteplase on myeloperoxidase, pregnancy-associated plasma protein A, soluble fibrin and D-dimer in acute myocardial infarction

Introduction: Acute coronary reperfusion is accomplished pharmacologically with intravenous thrombotytic therapy or mechanically with primary percutaneous coronary intervention (PCI). Methods: We have determined the immediate effects of the main coronary reperfusion procedures on the plasma concentrations of myeloperoxidase (MPO), pregnancy-associated plasma protein A (PAPP-A), fibrin monomer (FM) and D-dimer (DD). We studied a total of 38 patients admitted for ST-segment elevation infarct (STEMI). 18 patients were given thrombolytic therapy with tenecteplase and 20 were treated with primary PCl. Results: The plasma concentrations of PAPP-A increased by a factor of six to eight times (p < 0.001) following both reperfusion therapies. No significant increase was observed for MPO by either procedure. DD and FM concentrations both increased significantly following thrombolytic therapy, p=0.000, whereas only minor increases, although statistically significant for FM (p = 0.013), were noted after PCl. DD and FM were highly correlated prior to the two treatment regimens (R=0.91), and were still highly correlated after PCl (R=0.94) and thrombolytic therapy (R=0.86). No correlation was demonstrated between PAPP-A and markers of activated coagulation. Conclusions: This is the first report of a significant rise in the plasma concentration of PAPP-A after PCI as compared to thrombolytic treatment (p =0.002) and may indicate a greater impact of PCI than that of thrombolytic therapy on target coronary plaques. (c) 2006 Elsevier Ltd. AR rights reserved.