Circulation. 2003;108:1924-1926
Published online before print October 6, 2003, doi: 10.1161/01.CIR.0000096054.18485.07
Published online before print October 6, 2003, doi: 10.1161/01.CIR.0000096054.18485.07
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(Circulation. 2003;108:1924.)
© 2003 American Heart Association, Inc.
Brief Rapid Communications |
Circulating Pregnancy-Associated Plasma Protein A Predicts Outcome in Patients With Acute Coronary Syndrome but No Troponin I Elevation
From the Departments of Medicine (J.L., T.I., P.P.) and Biotechnology (Q.-P.Q., K.P.), University and University Central Hospital of Turku, Turku, Finland; and the Departments of Medicine (L.-M.V.-P.) and Clinical Chemistry (K.P.), Helsinki University Central Hospital, Helsinki, Finland.
Correspondence to Juha Lund, MD, Turku University Central Hospital, POB 52, FIN-20520 Turku, Finland. E-mail juha.lund{at}tyks.fi
Received March 26, 2003; de novo received June 20, 2003; revision received September 2, 2003; accepted September 2, 2003.
Background— Risk stratification in troponin (cTn)-negative acute coronary syndrome (ACS) remains a clinical challenge. We investigated the predictive value of circulating pregnancy-associated plasma protein A (PAPP-A), a novel marker of atherosclerotic plaque activity, in these patients.
Methods and Results— Two hundred consecutive hospitalized ACS patients were included, of whom 136 (69 men and 67 women; mean±SD age, 66±16 years) remained cTnI-negative for up to 24 hours. PAPP-A was measured at admission, 6 to 12 hours, and 24 hours. During 6-month follow-up, 26 (19.1%) of the cTnI-negative patients reached a primary end point (cardiovascular death, myocardial infarction, or revascularization). At a cutoff level of 2.9 mIU/L, elevated PAPP-A was an independent predictor of adverse outcome (adjusted risk ratio [RR], 4.6; 95% confidence interval, 1.8 to 11.8; P=0.002). Another independent predictor was admission CRP >2.0 mg/L (RR, 2.6; P=0.03).
Conclusions— Measurement of plasma PAPP-A, a zinc-binding matrix metalloproteinase, is a strong independent predictor of ischemic cardiac events and need of revascularization in patients who present with suspected myocardial infarction but remain troponin negative.
Key Words: proteins • plasma • pregnancy • atherosclerosis • prognosis
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