{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:15:50Z","timestamp":1785413750196,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"publisher","award":["2021ZD0111000"],"award-info":[{"award-number":["2021ZD0111000"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82070357"],"award-info":[{"award-number":["82070357"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["82070357"],"award-info":[{"award-number":["82070357"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Beijing Key Clinical Subject Program","award":["PX2018002"],"award-info":[{"award-number":["PX2018002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Pregnancy-associated plasma protein-A (PAPP-A)-derived N- and C-terminal fragments of IGF-binding protein-4 (NT- and CT-IGFBP-4) are released from vulnerable atherosclerotic plaques. This study investigated the prognostic value of PAPP-A and IGFBP-4 fragments in patients with acute myocardial infarction (AMI), especially in those combined with chronic kidney disease (CKD). Methods: This prospective study measured admission levels of PAPP-A, NT- and CT-IGFBP-4 in 341 consecutive AMI patients. Of these patients, 232 were diagnosed with CKD (AMI and CKD), which consisted predominantly of early-stage cases. The primary outcome was one-year major adverse cardiovascular and cerebrovascular events (MACCE), a composite of cardiovascular death, non-fatal MI, and stroke. Results: In the whole AMI cohort and the AMI and CKD subgroup, serum PAPP-A and NT-IGFBP-4 levels in patients with MACCE were both significantly higher than those in patients without MACCE, whereas CT-IGFBP-4 levels were similar. Multivariable Cox regression analysis revealed that increased levels of PAPP-A (HR, 2.48; 95% CI, 1.09\u20135.63; p = 0.030) and NT-IGFBP-4 (HR, 2.48; 95% CI, 1.03\u20136.02; p = 0.044) were associated with MACCE in the whole AMI cohort. The areas under the receiver operating characteristic (ROC) curve for PAPP-A and NT-IGFBP-4 were 0.637 and 0.633, respectively. However, in the AMI and CKD subgroups, only NT-IGFBP-4 was identified as an independent predictor of MACCE (HR, 2.72; 95% CI, 1.16\u20136.41; p = 0.021) and cardiovascular death (HR, 2.63; 95% CI, 1.01\u20136.84; p = 0.048). Conclusions: PAPP-A and NT-IGFBP-4 were independently associated with one-year MACCE. NT-IGFBP-4 may be a promising prognostic marker in AMI patients with early-stage CKD.<\/jats:p>","DOI":"10.3390\/jcm15155760","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:11:26Z","timestamp":1784797886000},"page":"5760","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Values of Pregnancy-Associated Plasma Protein-A and IGF-Binding Protein-4 Fragments in Patients with Acute Myocardial Infarction"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0452-6184","authenticated-orcid":false,"given":"Huan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zijian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Aerospace General Hospital, Beijing 100076, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyi","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dingkun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiping","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China"},{"name":"Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing 100050, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7018393","DOI":"10.1155\/2017\/7018393","article-title":"Ischemia\/Reperfusion Injury following Acute Myocardial Infarction: A Critical Issue for Clinicians and Forensic Pathologists","volume":"2017","author":"Neri","year":"2017","journal-title":"Mediat. 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