title: Pregnancy associated plasma protein A, a potential marker for vulnerable plaque in patients with non-ST-segment elevation acute coronary syndrome.
abstract: OBJECTIVE
  To describe the presence and time-related pattern of circulating pregnancy associated plasma protein A (PAPP-A) levels in patients with non ST-segment elevation acute coronary syndrome (NSTE-ACS).
  
  
  METHODS
  Consecutively admitted patients (N=573) with clinical signs of NSTE-ACS were included. Blood samples for analysis of PAPP-A were drawn at admission and every 6-8 h until levels of biomarkers of myocardial necrosis showed a consistent decrease.
  
  
  RESULTS
  High-risk NSTE-ACS was diagnosed in 123 patients (23%). Significantly more patients with high-risk NSTE-ACS (63%) had detectable PAPP-A than did those with low-risk NSTE-ACS (49%) (P<0.001). PAPP-A concentrations were significantly associated with typical angina at admission, significant ST-depressions on the ECG, multivessel disease and presence of high-risk NSTE-ACS.
  
  
  CONCLUSIONS
  PAPP-A seems to be a marker ischaemia both in patients with low- and high-risk NSTE-ACS, possibly due to the release of PAPP-A from the vulnerable plaque.
authors.affiliation: Department of Cardiology, Hillerod Hospital, Helsevej 2, 3400 Hillerod, Denmark. kasper.iversen@dadlnet.dk
authors.forename: Kasper K
authors.initials: KK
authors.lastname: Iversen
authors.forename: Ane S
authors.initials: AS
authors.lastname: Teisner
authors.forename: Borge
authors.initials: B
authors.lastname: Teisner
authors.forename: Anette
authors.initials: A
authors.lastname: Kliem
authors.forename: Pia
authors.initials: P
authors.lastname: Thanning
authors.forename: Henrik
authors.initials: H
authors.lastname: Nielsen
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Peer
authors.initials: P
authors.lastname: Grande