title: The utility of pregnancy-associated plasma protein A for determination of prognosis in a cohort of patients with coronary artery disease.
abstract: BACKGROUND
  Pregnancy-associated plasma protein-A (PAPP-A) is discussed as a biomarker representing unstable plaques in coronary artery disease (CAD).
  
  
  METHODS
  In this study 927 patients with CAD (534 with stable angina and 393 with acute coronary syndrome [ACS]) and 217 patients without CAD and measured PAPP-A levels were included. Follow-up for a median of 5 years was documented.
  
  
  RESULTS
  Rising quartiles of PAPP-A concentration had a higher cardiovascular mortality in the overall cohort of patients with CAD (p = 0.002) and the cohort with ACS (p = 0.01). Patients with suspected ACS below the LOD for troponin I but elevated PAPP-A levels had an increased cardiovascular mortality. A cut-off of 11.4 IU/l identified patients with a higher mortality during follow-up.
  
  
  CONCLUSIONS
  Rising PAPP-A levels are prognostic in patients with CAD. PAPP-A levels were especially predictive in ACS patients with troponin below 10% CV of the 99 th percentile for cardiovascular mortality.
authors.affiliation: Department of General & Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Elvin
authors.initials: E
authors.lastname: Zengin
authors.affiliation: Department of General & Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sinning
authors.affiliation: Department of General & Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.affiliation: Department of Medicine II, GPR Rüsselsheim, August-Bebel-Straße 59, 65428 Rüsselsheim, Germany.
authors.forename: Hans-J
authors.initials: HJ
authors.lastname: Rupprecht
authors.affiliation: Department of General & Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.affiliation: Institute of Clinical Chemistry & Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
authors.forename: Karl-J
authors.initials: KJ
authors.lastname: Lackner
authors.affiliation: Department of General & Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.affiliation: Department of General & Interventional Cardiology, University Heart Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Westermann
authors.affiliation: Department of Internal Medicine, Federal Armed Forces Central Hospital, Rübenacher Straße 170, 56072 Koblenz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D011266:Pregnancy-Associated Plasma Protein-A
keywords: acute coronary syndrome; coronary artery disease; pregnancy-associated plasma protein-A; unstable angina; unstable plaque