title: PAPP-A as a marker of increased long-term risk in patients with chest pain.
abstract: OBJECTIVE
  Long-term risk stratification in patients presenting with acute coronary syndromes (ACS) is possible by measuring cardiac troponin (cTn). The present study examined whether PAPP-A measured in an emergency department (ED) chest pain population in association with conventional and novel high sensitivity cTn (hs-cTnI) assays can predict long-term mortality.
  
  
  METHODS
  In 320 patients with cTn measurements the earliest heparinized plasma PAPP-A concentration after presentation was used for risk stratification for death by Kaplan-Meier and Cox analyses. Subgroup analyses using the earliest PAPP-A concentrations were also performed in a cohort of subjects with presentation cTnI < or = 99th percentile but with significantly changing cardiac troponin concentrations as measured by the AccuTnI assay and the hs-cTnI assay (n=45 and 120 subjects, respectively).
  
  
  RESULTS
  Subjects with PAPP-A concentrations in the highest tertile were at higher risk for death (HR > 2.00; p < or = 0.05 at 2 years) even after adjusting for cTnI at presentation. In the cohort with cTnI < or = 99th percentile but with changing hs-cTnI concentrations, subjects in the top PAPP-A tertile had a higher probability for death (p=0.02).
  
  
  CONCLUSIONS
  Early measurement of PAPP-A may identify chest pain patients at higher risk for long-term death. Additional prospective ACS studies are required to fully elucidate PAPP-A's role.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada. kavsakp@mcmaster.ca
authors.forename: Peter A
authors.initials: PA
authors.lastname: Kavsak
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Matthew
authors.initials: M
authors.lastname: Henderson
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.forename: Andrew R
authors.initials: AR
authors.lastname: MacRae
authors.forename: Allan S
authors.initials: AS
authors.lastname: Jaffe