title: Association between plasma pregnancy-associated plasma protein a and restenosis after percutaneous coronary angioplasty.
abstract: BACKGROUND
  Restenosis after percutaneous coronary angioplasty remains an important limitation of this procedure. This study evaluates the association between plasma pregnancy-associated plasma protein A (PAPP-A) levels and restenosis after coronary angioplasty.
  
  
  RESULTS
  Blood samples were collected from all patients at baseline, and their levels of PAPP-A, inflammation (high-sensitivity C-reactive protein (hsCRP)) and platelet activation (soluble CD40 ligand (sCD40L)) were determined. Those patients whose PCI was successful underwent a repeat angiography at a median of 6.4 months (interquartile range 6-9.8 months). Their baseline and follow-up angiograms were compared by quantitative coronary angiography to assess the incidence of restenosis. Endpoints were restenosis (> or =50%) and a composite of major adverse cardiac events. Of the 184 patients, 162 patients underwent an angiographic follow up at 6 months. Patients with restenosis had significantly higher PAPP-A levels than those without (19.24+/-2.56 vs 11.95+/-2.32 mIu/L; p<0.001). The PAPP-A levels were significantly correlated to follow up diameter stenosis (r=0.54, p=0.01). Late lumen loss at follow-up was significantly smaller when PAPP-A levels were <12.51 mIu/L (0.55+/-0.61 vs 0.90+/-0.57 mm; p<0.001). The rates for restenosis (28.4 vs 50.6%; p<0.001) and major advent cardiac events (15.6 vs 51.1%, p<0.001) were significantly lower in patients with PAPP-A levels <12.51 mIu/L. Univariate analysis revealed that PAPP-A (p<0.001), hsCRP (p=0.009) and sCD40L (p=0.03) were significantly related to restenosis. However, only PAPP-A could predict restenosis (odds ratio 0.95; 95% confidence interval 0.84-1.13; p=0.02) in multivariate analysis.
  
  
  CONCLUSIONS
  The PAPP-A level is a strong independent predictor of restenosis in patients who have undergone coronary angioplasty.
authors.affiliation: Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xu-Ping
authors.initials: XP
authors.lastname: Li
authors.forename: Sheng Hua
authors.initials: SH
authors.lastname: Zhou
authors.forename: Jian Jun
authors.initials: JJ
authors.lastname: Tang
authors.forename: Qi Ming
authors.initials: QM
authors.lastname: Liu
authors.forename: Zheng Fei
authors.initials: ZF
authors.lastname: Fang
authors.forename: Xing Qun
authors.initials: XQ
authors.lastname: Hu
authors.forename: Tao
authors.initials: T
authors.lastname: Zhou
authors.forename: Xiang Qian
authors.initials: XQ
authors.lastname: Sheng
authors.forename: Shui Ping
authors.initials: SP
authors.lastname: Zhao
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D023903:Coronary Restenosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A