title: Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease: Novel Findings From 3-Vessel Virtual Histology Intravascular Ultrasound Assessment.
abstract: Pregnancy-associated plasma protein-A (PAPP-A) level is an independent predictor of acute cardiovascular event occurrence. To test the hypothesis that increased PAPP-A levels would be associated with a higher burden of coronary thin-cap fibroatheroma (TCFA) thereby underlying the heightened risk for cardiovascular events in patients with coronary artery disease; 154 patients (462 vessels and 975 plaques) with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) referred for percutaneous coronary intervention were assessed using 3-vessel virtual histology (VH)-intravascular ultrasound (IVUS). Thin-cap fibroatheroma virtual histology was defined as focal, necrotic core (NC)-rich (≥10% of cross-sectional area) plaques in contact with the lumen, and plaque burden ≥40%. Pregnancy-associated plasma protein-A levels were determined by sandwich enzyme-linked immunosorbent assay, and patients were divided into 3 groups based on PAPP-A level tertiles. Although the highest PAPP-A level tertile was not associated with 3-vessel plaque number, it was associated with 3-vessel VH-TCFA number and necrotic core volume. Patients with ≥3 VH-TCFAs had a higher PAPP-A level than patients with 1 to 3 VH-TCFAs or without any VH-TCFA (13.3 ± 11.8 versus 7.8 ± 4.7 versus 7.4 ± 4.7 mIU/L, P < 0.001, respectively). Moreover, PAPP-A level was an independent predictor of higher total number of VH-TCFAs (OR 1.18; 95% CI 1.07-1.29, P = 0.001). This VH-IVUS study demonstrated, for the first time to our knowledge, that higher PAPP-A levels are associated with higher 3-vessel TCFA burden in patients with coronary artery disease. Pregnancy-associated plasma protein-A, therefore, might be a useful serum biomarker to predict increased coronary TCFA burden and plaque instability.
authors.affiliation: From the Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University (X-FW, HG, Y-CZ, C-JG); Beijing Institute of Heart, Lung and Blood Vessel Disease (MY, L-YW); Department of Physiology and Pathophysiology, Capital Medical University, Beijing, China (A-JQ); Cardiovascular Research Foundation, New York, NY (GSM); Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing (YY); Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang (Y-PS); and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (LW, JP).
authors.forename: Xiao-Fan
authors.initials: XF
authors.lastname: Wu
authors.forename: Min
authors.initials: M
authors.lastname: Yang
authors.forename: Ai-Juan
authors.initials: AJ
authors.lastname: Qu
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Ya
authors.initials: Y
authors.lastname: Yang
authors.forename: Yun-Peng
authors.initials: YP
authors.lastname: Shang
authors.forename: Hai
authors.initials: H
authors.lastname: Gao
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Zhang
authors.forename: Chang-Jiang
authors.initials: CJ
authors.lastname: Ge
authors.forename: Lu-Ya
authors.initials: LY
authors.lastname: Wang
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Pu
mesh_terms: D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D012720:Severity of Illness Index; D014463:Ultrasonography
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A
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