title: Prognostic value of circulating pregnancy-associated plasma protein levels in patients with chronic stable angina.
abstract: OBJECTIVE
  Unstable coronary atherosclerotic plaque can be present in patients with chronic stable coronary artery disease (CAD). Our objective was to assess whether measurement of plasma pregnancy-associated plasma protein (PAPP-A) level, a reflection of plaque instability, in patients with chronic stable CAD had an independent prognostic value on the subsequent incidence of death, acute coronary syndrome (ACS), and revascularization.
  
  
  RESULTS
  Patients referred for coronary angiography were recruited. A cohort of 103 patients with stable symptoms for at least 6 weeks and with a coronary angiogram showing at least a 50% luminal diameter narrowing formed our study population. Median follow-up was 4.9 years. Mean age was 65+/-10 years. In a multivariable model that included CAD traditional risk factors, ejection fraction, extent of coronary atherosclerosis, prior history of myocardial infarction, prior revascularization, discharge medications, and C-reactive protein, the plasma PAPP-A was found to be significantly associated with the endpoint of future death [adjusted hazard ratio (HR) 5.29; 95% CI 1.27-22.0; P=0.023] and with the endpoint of future death and ACS (adjusted HR 3.56; 95% CI 1.27-10.0; P=0.015), but not with the endpoint of future death and revascularization.
  
  
  CONCLUSIONS
  Measurement of plasma PAPP-A level in patients with chronic stable CAD has an independent prognostic value on the occurrence of death and ACS.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Elesber
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Conover
authors.forename: Ali E
authors.initials: AE
authors.lastname: Denktas
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Michael T
authors.initials: MT
authors.lastname: Overgaard
authors.forename: Michael
authors.initials: M
authors.lastname: Christiansen
authors.forename: Claus
authors.initials: C
authors.lastname: Oxvig
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000401:mortality*; D002423:Cause of Death; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D009204:Myocardial Revascularization; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis; D012307:Risk Factors
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A