Circulating Pregnancy-Associated Plasma Protein A Predicts Outcome in Patients With Acute Coronary Syndrome but No Troponin I Elevation
作者:
Juha Lund,
Qiu-Ping Qin,
Tuomo Ilva,
Kim Pettersson,
Liisa-Maria Voipio-Pulkki,
Pekka Porela,
Kari Pulkki,
期刊:
Circulation: Journal of the American Heart Association
(OVID Available online 2003)
卷期:
Volume 108,
issue 16
页码: 1924-1926
ISSN:0009-7322
年代: 2003
出版商: OVID
关键词: proteins;plasma;pregnancy;atherosclerosis;prognosis
数据来源: OVID
摘要:
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.
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