title: Usefulness of pregnancy-associated plasma protein A in patients with acute coronary syndrome.
abstract: To investigate whether pregnancy-associated plasma protein-A (PAPP-A) is a prognostic marker in patients admitted with high-risk acute coronary syndrome. In patients admitted with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and ST-segment elevation myocardial infarction (STEMI), risk stratification is primarily determined by the markers of myocardial necrosis and known demographic risk profiles. However, it has recently been proposed that the presence and extent of vulnerable plaques might influence the prognosis significantly. A marker for the vulnerable plaque could identify patients at high risk who would potentially benefit from intensive treatment and surveillance. Two populations of consecutive patients admitted with high-risk NSTE-ACS (n = 123) and STEMI (n = 314) were evaluated with serial measurements of PAPP-A. The incidence of mortality and nonfatal myocardial infarction was prospectively registered for 2.66 to 3.47 years. In the patients with high-risk NSTE-ACS, PAPP-A was related to the risk of nonfatal myocardial infarction (p = 0.02) and death (p = 0.03). This result was consistent on multivariate analysis of the combination of mortality or nonfatal myocardial infarction (odds ratio 2.65, 95% confidence interval 1.40 to 5.03) but not for mortality alone (p = NS). In patients with STEMI, PAPP-A was related to the risk of death (p = 0.01) but not the composite outcome of myocardial infarction and death. This was also true after adjustment for other univariate predictors of death (odds ratio 2.19, 95% confidence interval 1.16 to 4.16). In conclusion, PAPP-A seems to be valuable in predicting the outcomes of patients admitted with high-risk NSTE-ACS or STEMI.
authors.affiliation: Department of Cardiology, Hillerod Hospital, Hillerod, Denmark. kasper.iversen@dadlnet.dk
authors.forename: Kasper K
authors.initials: KK
authors.lastname: Iversen
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.forename: Ane S
authors.initials: AS
authors.lastname: Teisner
authors.forename: Mikkel
authors.initials: M
authors.lastname: Schoos
authors.forename: Borge
authors.initials: B
authors.lastname: Teisner
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
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003718:Denmark / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A