Evaluation of pregnancy-associated plasma protein A as a prognostic indicator in acute coronary syndrome patients

• Published in: Clinica chimica acta 2004-10, Vol.348 (1), p.163-169
• Main Authors: Laterza, Omar F., Cameron, Scott J., Chappell, Derek, Sokoll, Lori J., Green, Gary B.
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute Disease; Adverse events; Biomarkers - blood; Coronary Disease - diagnosis; Coronary Disease - epidemiology; cTnT; Emergency Service, Hospital; Female; Humans; Immunoassay; Linear Models; Male; Middle Aged; PAPP-A; Pregnancy-Associated Plasma Protein-A - analysis; Prognosis; Risk Assessment; Sensitivity and Specificity; Troponin T - blood
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cccn.2004.05.022

Background: Higher circulating concentrations of pregnancy-associated plasma protein A (PAPP-A), a potential proatherosclerotic metalloproteinase, have been associated with increased risk for acute coronary syndrome (ACS). Our goal was to determine the ability of circulating concentrations of PAPP-A to predict adverse events in patients presenting to the Emergency Department (ED) with symptoms of ACS. Methods: A total of 346 patients with symptoms of ACS were included in the study. Serum samples obtained immediately after enrollment were analyzed for PAPP-A and cardiac troponin T (cTnT). The occurrence of adverse events during a 30-day follow-up period was recorded, and receiver-operating characteristic (ROC) curve analysis was performed to evaluate the prognostic characteristics of PAPP-A and cTnT. Results: A total of 33 (9.5 %) patients developed adverse events during the follow up period. At a cut-off concentration of 0.22 mIU/l, PAPP-A was a predictor of adverse events with a sensitivity and specificity (95% C.I.) of 66.7% (48.2–82.0) and 51.1% (45.4–56.8), respectively. The sensitivity and specificity of cTnT were 51.5% (33.6–69.2) and 82.1% (77.4–86.2), respectively, using a 0.01-ng/ml cut-off value, which was obtained using ROC analysis. Conclusions: PAPP-A appears to be a modest predictor of adverse events in patients presenting to the ED with ACS symptoms, being inferior to cTnT in predicting adverse events in an ED setting. PAPP-A appears to be as sensitive as cTnT, but it is less specific.