on March 15, 2004
Published online before print March 15, 2004, doi: 10.1161/01.CIR.0000124716.67921.D2
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Submitted on August 22, 2003
From the Department of Cardiac and Vascular Sciences (J.C.-S., P.K., D.C., D.W.H., J.C.K.), St George’s Hospital Medical School, London, UK; Department of Clinical Biochemistry (M.C.), Statens Serum Institut, Copenhagen, Denmark; Copenhagen Heart Arrhythmia Research Center (M.C.), Copenhagen, Denmark; and Department of Molecular Biology (C.O., M.T.O.), Science Park, University of Aarhus, Aarhus, Denmark. * To whom correspondence should be addressed. E-mail: jkaski{at}sghms.ac.uk.
Background--The metalloproteinase pregnancy-associated plasma protein-A (PAPP-A) has been implicated in coronary plaque disruption. Its endogenous inhibitor, the proform of eosinophil major basic protein (proMBP), may also play a role in this process. Atheromatous plaque disruption often presents as complex angiographic lesions. We sought to assess whether PAPP-A, proMBP, and PAPP-A/ProMBP ratio are markers of angiographic plaque complexity in patients with chronic stable angina. Methods and Results--We studied 396 stable angina patients (age 63±10 years, 230 men) of whom 289 had angiographically documented coronary artery disease ( Conclusions--In patients with stable angina, PAPP-A and PAPP-A/proMBP ratio are associated with angiographic plaque complexity.
Revised on December 9, 2003
Accepted on January 28, 2004
Pregnancy-Associated Plasma Protein A and Its Endogenous Inhibitor, the Proform of Eosinophil Major Basic Protein (proMBP), Are Related to Complex Stenosis Morphology in Patients With Stable Angina Pectoris
Juan Cosin-Sales MD,
75% stenosis). All coronary stenoses 30% diameter reduction (n =531 in 322 patients) were assessed and classified as complex (n =228) or smooth (n =303) by previously validated criteria. PAPP-A, proMBP, and C-reactive protein (hs-CRP) serum levels were measured by ELISA. Patients with complex coronary stenoses had a significantly (P<0.001) higher PAPP-A/proMBP ratio (3.1±1.2 versus 2.7±0.8x10-3) and PAPP-A levels (5.9±1.6 versus 5.1±1.4 mIU/L) than those without. On univariate analysis, male gender (P<0.001), age (P<0.001), previous history of myocardial infarction (P=0.013), reduced ejection fraction (P<0.001), severe coronary artery disease (P<0.001), aspirin treatment (P<0.001), PAPP-A levels (P<0.001), and PAPP-A/proMBP ratio (P<0.001) were correlated with the number of complex stenoses. Multiple regression analysis showed that male gender, age, severe coronary artery disease, and PAPP-A/proMBP ratio were independent predictors of the number of angiographically complex stenoses.
Key words: atherosclerosis • coronary disease • plaque complexity • metalloproteinases
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