Circulating Pregnancy-Associated Plasma Protein A Predicts Outcome in Patients With Acute Coronary Syndrome but No Troponin I Elevation

Lund, Juha; Qin, Qiuping; Ilva, Tuomo; Pettersson, Kim; Voipio‐Pulkki, Liisa‐Maria; Porela, Pekka; Pulkki, Kari

doi:10.1161/01.cir.0000096054.18485.07

Cited by 207 publications

(155 citation statements)

References 17 publications

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“…Pregnancy associated plasma protein-A appeared to be an independent predictor of future ischaemic events as well as the need for percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery. 5 Similar findings were reported by Heeschen et al 6 who observed raised PAPP-A in ACS than stable angina and patients without evidence for CAD. Mean PAPP-A levels in NSTEMI patients did not significantly differ from mean PAPP-A levels in UA.…”

Section: Discussionsupporting

confidence: 82%

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Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome

Gururajan

Gurumurthy

Nayar

et al. 2012

Indian Heart Journal

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Aims and objectives: Pregnancy associated plasma protein-A (PAPP-A), a metalloproteinase plays apivotal role in the pathogenesis of atherosclerosis. Recent studies have reported that elevated levels of PAPP-A, signal the onset of acute coronary syndrome (ACS). We, therefore, proposed to study the analytical competence of PAPP-A in patients admitted to the emergency department with chest pain and finally diagnosed as ACS. Methods and results:Pregnancy associated plasma protein-A was measured using enzyme-linked immunosorbent assay (ELISA) in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as Non-cardiac chest pain (NCCP). Elevated levels of PAPP-A were observed in patients diagnosed as ACS on comparison with the controls. Receiver operator characteristic (ROC) curve analysis showed PAPP-A to be a good discriminator between ischaemic and nonischaemic patients. The area under the curve was found to be 0.904, 95% CI (0.874-0.929) with 90% sensitivity and 85% specificity (P < 0.0001). The cut-off value from the ROC curve was 0.55 μg/ mL above which PAPP-A was considered to be positive. Conclusion:Pregnancy associated plasma protein-A seems to be a promising biomarker for identification and risk stratification for patients with ACS.

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Section: Discussionsupporting

confidence: 82%

“…Later, several studies have reported that circulating (elevated) levels of PAPP-A, independently predict the risk of an ischaemic event. 5,6 Uncomplexed form of PAPP-A is elevated in ACS. Binding of pro major basic protein (MBP) to PAPP-A molecule is hindered due to oxidative stress in the microenvironment of the plaque.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome

Gururajan

Gurumurthy

Nayar

et al. 2012

Indian Heart Journal

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“…53 PAPP-A levels Ͼ10 mIU/L were found to identify ACS with a sensitivity of 89% and a specificity of 81%, but the study population was small. 54 A larger population was studied by Lund and colleagues, 55 who found a strong correlation between PAPP-A and the combined end point death-MI-revascularization at 6 months in 200 patients with ACS. In this study, CRP was also an independent marker of risk but no comparison between the 2 was made.…”

Section: Other Inflammatory Markersmentioning

confidence: 99%

CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease

Biasucci¹

2004

Circulation

153

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Abstract-Inflammation is a recognized key component of acute coronary syndromes. Such pathogenetic achievement has led to the use of inflammatory cells and proteins as prognostic markers in these syndromes. A number of markers have been proposed, including proinflammatory cytokines such as interleukin-6, interleukin-1RA, and tumor necrosis factor-␣, adhesion molecules such as intracellular adhesion molecule-1 and vascular adhesion molecule-1 and markers of cell activation. Although all are of scientific interest, the clinical use of these markers is limited by their high cost, low availability, and unfavorable biological profile. Conversely, common markers of inflammation such as C-reactive protein (CRP), the prototypic acute phase protein, and to a lesser extent fibrinogen, have been proven to be reliable and important markers of risk in ischemic heart disease. CRP, in particular, has been found to be associated with short-and long-term prognosis in acute coronary syndromes, including ST-elevation myocardial infarction, and in stable angina, and to predict the risk of restenosis and major events, including death, after revascularization procedures. CRP has been consistently found to be independent from other risk factors and to have an incremental value beyond the common risk factors and biochemical markers of risk, including troponin. Whether CRP also should be used as a guide to therapy is still a matter of discussion that deserves further, properly designed studies. Key Words: AHA Scientific Statements Ⅲ inflammation Ⅲ revascularization Ⅲ angina Ⅲ risk factors S hort-and long-term prediction of risk in patients with acute coronary syndromes (ACS) is a challenging clinical problem. Despite diagnostic and therapeutic advances, the rate of event recurrence is still relatively high (in the range of 14% to 16% at 6 months 1,2 ). The growing evidence that inflammation plays a pivotal role in the pathogenesis of most of the cases of ACS 3 led to the use of inflammatory mediators as markers of risk in these syndromes. 4 As consistent data have been accumulated in this area, risk prediction in ischemic heart disease and in ACS in particular represents the main use of inflammatory markers in cardiovascular medicine. More recently, sparse but intriguing data have been published suggesting that inflammatory markers may represent a marker of risk in other cardiovascular conditions. C-Reactive ProteinA number of inflammatory mediators have been studied as markers of risk in ischemic heart disease. They are discussed separately. Although many of them are of potential clinical interest (discussed below), C-reactive protein (CRP) is the inflammatory marker most extensively assessed in prognostic studies and is an almost perfect marker of inflammation (it has a half-life of 19 hours and is neither consumed nor produced during the reaction). This is the result, in part, of analytical reasons because of the availability of high-sensitivity, relatively low-cost methods for its measurement and in part because of its biological pr...

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“…9 PaPPA levels following chest pain predict the risk of MI and revascularization. 10 PaPPA is a proatherosclerotic metalloproteinase 11 that has been isolated in other damaged tissue. It has been found to promote repair, thus revealing its role as an inflammation suppressor.…”

Section: Article P 2197mentioning

confidence: 99%

Need and Importance of Biomarkers to Predict Acute Myocardial Infarction and Its Prognosis

Hata

2012

Circ J

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Circulating Pregnancy-Associated Plasma Protein A Predicts Outcome in Patients With Acute Coronary Syndrome but No Troponin I Elevation

Cited by 207 publications

References 17 publications

Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome

Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome

CDC/AHA Workshop on Markers of Inflammation and Cardiovascular Disease

Need and Importance of Biomarkers to Predict Acute Myocardial Infarction and Its Prognosis

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