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02-04-2013 | Cardiology | Article

Pregnancy-associated plasma protein A as a predictor for CV events


Free abstract

medwireNews: Levels of pregnancy-associated plasma protein A (PAPP-A) may predict risk for a cardiovascular (CV) event among individuals presenting with cardiac chest pain, researchers find.

Their study showed that increased levels of PAPP-A were significantly associated with an increased short-term risk for stent thrombosis, myocardial (re)infarction, ischemic stroke, and CV-related death among such patients.

Stephan von Haehling (Charité Medical School, Berlin, Germany) and colleagues analysed 2568 patients, aged a mean of 68 years, who presented with chest pain of cardiac origin, as confirmed by coronary angiography. A total of 1339 (52.1%) had stable angina (defined as symptoms of angina pectoris without progression and a troponin I level below 0.04 ng/mL) while the remainder had acute coronary syndrome, as defined by American Heart Association guidelines.

As reported in the Canadian Medical Association Journal, the mean PPAP-A level was 24.6 mIU/L, and ranged from 4.1 mIU/L to 2154.4 mIU/L.

Blood samples for PAPP-A analysis were drawn within 30 minutes after patients arrived at the emergency department or in the catheterization laboratory. All patients were subsequently followed up by telephone interviews or outpatient office visits for 90 days or until death.

During follow up, 203 (7.9%) patients experienced 245 major CV events, of which 58 events were stent thrombosis, 98 were myocardial (re)infarction, 18 were ischemic stroke, and 71 were CV-related death.

Patients who experienced a CV event had a significantly higher mean PAPP-A level than those who did not experience such an event, at 62.0 mIU/L compared with 21.4 mIU/L.

In multivariate analysis, PAPP-A level was a significant predictor for CV events, with each standard deviation increase in PAPP-A level associated with a 1.96-fold increased likelihood for experiencing a CV event within 90 days. Further analysis showed that the optimal cut-off value for PAPP-A level as a predictor for CV events was 34.6 mIU/L.

"Our findings support the results of earlier studies that suggested PAPP-A as a marker of unstable atherosclerotic plaques," say the researchers, who suggest that further studies should be carried out to validate the use of PAPP-A level in routine clinical practice as a predictor of future CV events.

"If these studies are successful, PAPP-A measurements could play a role in reducing morbidity and mortality from coronary disease," concludes the team.

By Sally Robertson, medwireNews Reporter

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