title: Circulating pregnancy-associated plasma protein a predicts outcome in patients with acute coronary syndrome but no troponin I elevation.
abstract: BACKGROUND
  Risk stratification in troponin (cTn)-negative acute coronary syndrome (ACS) remains a clinical challenge. We investigated the predictive value of circulating pregnancy-associated plasma protein A (PAPP-A), a novel marker of atherosclerotic plaque activity, in these patients.
  
  
  RESULTS
  Two hundred consecutive hospitalized ACS patients were included, of whom 136 (69 men and 67 women; mean+/-SD age, 66+/-16 years) remained cTnI-negative for up to 24 hours. PAPP-A was measured at admission, 6 to 12 hours, and 24 hours. During 6-month follow-up, 26 (19.1%) of the cTnI-negative patients reached a primary end point (cardiovascular death, myocardial infarction, or revascularization). At a cutoff level of 2.9 mIU/L, elevated PAPP-A was an independent predictor of adverse outcome (adjusted risk ratio [RR], 4.6; 95% confidence interval, 1.8 to 11.8; P=0.002). Another independent predictor was admission CRP >2.0 mg/L (RR, 2.6; P=0.03).
  
  
  CONCLUSIONS
  Measurement of plasma PAPP-A, a zinc-binding matrix metalloproteinase, is a strong independent predictor of ischemic cardiac events and need of revascularization in patients who present with suspected myocardial infarction but remain troponin negative.
authors.affiliation: Department of Medicine, University and Turku University Central Hospital, POB 52, FIN-20520 Turku, Finland. juha.lund@tyks.fi
authors.forename: Juha
authors.initials: J
authors.lastname: Lund
authors.forename: Qiu-Ping
authors.initials: QP
authors.lastname: Qin
authors.forename: Tuomo
authors.initials: T
authors.lastname: Ilva
authors.forename: Kim
authors.initials: K
authors.lastname: Pettersson
authors.forename: Liisa-Maria
authors.initials: LM
authors.lastname: Voipio-Pulkki
authors.forename: Pekka
authors.initials: P
authors.lastname: Porela
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D002097:C-Reactive Protein; D011266:Pregnancy-Associated Plasma Protein-A