on October 6, 2003
Circulation. 2003
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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Submitted on March 26, 2003
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. * To whom correspondence should be addressed. E-mail: juha.lund{at}tyks.fi.
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.
Revised on September 2, 2003
Accepted on September 2, 2003
Circulating Pregnancy-Associated Plasma Protein A Predicts Outcome in Patients With Acute Coronary Syndrome but No Troponin I Elevation
Juha Lund MD*,
Key words: proteins • plasma • pregnancy • atherosclerosis • prognosis
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