title: Evaluation of pregnancy-associated plasma protein A as a prognostic indicator in acute coronary syndrome patients.
abstract: BACKGROUND
  Higher circulating concentrations of pregnancy-associated plasma protein A (PAPP-A), a potential proatherosclerotic metalloproteinase, have been associated with increased risk for acute coronary syndrome (ACS). Our goal was to determine the ability of circulating concentrations of PAPP-A to predict adverse events in patients presenting to the Emergency Department (ED) with symptoms of ACS.
  
  
  METHODS
  A total of 346 patients with symptoms of ACS were included in the study. Serum samples obtained immediately after enrollment were analyzed for PAPP-A and cardiac troponin T (cTnT). The occurrence of adverse events during a 30-day follow-up period was recorded, and receiver-operating characteristic (ROC) curve analysis was performed to evaluate the prognostic characteristics of PAPP-A and cTnT.
  
  
  RESULTS
  A total of 33 (9.5 %) patients developed adverse events during the follow up period. At a cut-off concentration of 0.22 mIU/l, PAPP-A was a predictor of adverse events with a sensitivity and specificity (95% C.I.) of 66.7% (48.2-82.0) and 51.1% (45.4-56.8), respectively. The sensitivity and specificity of cTnT were 51.5% (33.6-69.2) and 82.1% (77.4-86.2), respectively, using a 0.01-ng/ml cut-off value, which was obtained using ROC analysis.
  
  
  CONCLUSIONS
  PAPP-A appears to be a modest predictor of adverse events in patients presenting to the ED with ACS symptoms, being inferior to cTnT in predicting adverse events in an ED setting. PAPP-A appears to be as sensitive as cTnT, but it is less specific.
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe St. Meyer B125, Baltimore, MA 21287, USA. omar.laterza@gmail.com
authors.forename: Omar F
authors.initials: OF
authors.lastname: Laterza
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Cameron
authors.forename: Derek
authors.initials: D
authors.lastname: Chappell
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Sokoll
authors.forename: Gary B
authors.initials: GB
authors.lastname: Green
mesh_terms: D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007118:Immunoassay; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T; D011266:Pregnancy-Associated Plasma Protein-A