Association between plasma pregnancy-associated plasma protein a and restenosis after percutaneous coronary angioplasty.
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.
Li
Xu-Ping
XP
Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Zhou
Sheng Hua
SH
Tang
Jian Jun
JJ
Liu
Qi Ming
QM
Fang
Zheng Fei
ZF
Hu
Xing Qun
XQ
Zhou
Tao
T
Sheng
Xiang Qian
XQ
Zhao
Shui Ping
SP
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
D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A