title: Pregnancy associated plasma protein-A and risk stratification of patients presenting with chest pain in the emergency department.
abstract: BACKGROUND
  The aim of this study was to evaluate the clinical utility of serum pregnancy associated plasma protein-A (PAPP-A) levels in assisting triage of an intermediate to high-risk patient presenting with chest pain in the Emergency Department and no definite evidence of an acute coronary syndrome.
  
  
  METHODS
  Serum levels of PAPP-A were measured in 59 patients presenting with chest pain to the Emergency Department. The patients were independently grouped according to the presence of acute coronary syndromes or the absence thereof.
  
  
  RESULTS
  In a multivariate model that corrected for age, sex, type of chest pain, number of risk factors, history of coronary artery disease, troponin levels, and non-specific ECG changes, PAPP-A levels were still predictive of a final diagnosis of acute coronary syndrome in patients presenting with chest pain to the Emergency Department (Odds Ratio, 2.093; 95th confidence intervals, 1.037-4.224; p=0.039).
  
  
  CONCLUSIONS
  Elevated serum PAPP-A levels were predictive of a diagnosis of acute coronary syndrome in intermediate- to high-risk patients presenting to the Emergency Department with chest pain and no definite evidence of an acute coronary syndrome. Thus, serum PAPP-A may be valuable as an adjunct, minimally invasive marker to improve risk stratification in chest pain patients.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Elesber
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.forename: Ali E
authors.initials: AE
authors.lastname: Denktas
authors.forename: Zachary T
authors.initials: ZT
authors.lastname: Resch
authors.forename: T
authors.initials: T
authors.lastname: Jared Bunch
authors.forename: Robert S
authors.initials: RS
authors.lastname: Schwartz
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Conover
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000175:diagnosis*; D002637:Chest Pain / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D018570:Risk Assessment; D013577:Syndrome
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A