Document Detail

Free vs total pregnancy-associated plasma protein A (PAPP-A) as a predictor of 1-year outcome in patients presenting with non-ST-elevation acute coronary syndrome.
MedLine Citation:
PMID:  20448189     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The free fraction of pregnancy-associated plasma protein A (FPAPP-A) was found to be the PAPP-A form released to the circulation in acute coronary syndrome (ACS). We estimated the prognostic value of FPAPP-A vs total PAPP-A (TPAPP-A) concentrations in forecasting death and nonfatal myocardial infarction (combined endpoint) in patients with non-ST-elevation ACS. METHODS: We recruited 267 patients hospitalized for symptoms consistent with non-ST-elevation ACS and followed them for 12 months. FPAPP-A, TPAPP-A, C-reactive protein (CRP), and cardiac troponin I (cTnI) were measured at admission; cTnI was also measured at 6-12 h and 24 h. Because of the recently shown interaction between PAPP-A and heparin, we excluded patients treated with any heparin preparations before the admission blood sampling. RESULTS: During the follow-up, 57 (21.3%) patients met the endpoint (22 deaths and 35 nonfatal myocardial infarctions). According to FPAPP-A (<1.27, 1.27-1.74, >1.74 mIU/L) and TPAPP-A (<1.98, 1.98-2.99, >2.99 mIU/L) tertiles, this endpoint was met by 12 (13.5%), 18 (20.2%), 27 (30.3%) (P = 0.02), and 17 (19.1%), 17 (19.1%), 23 (25.8%) (P = 0.54) patients, respectively. After adjusting for age, sex, diabetes, previous myocardial infarction, and ischemic electrocardiogram (ECG) findings, FPAPP-A >1.74 mIU/L [risk ratio (RR) 2.0; 95% CI 1.0-4.1, P = 0.053), increased cTnI, and CRP >/=2.0 mg/L were independent predictors of an endpoint. The prognostic performance of TPAPP-A was inferior to that of FPAPP-A. CONCLUSIONS: FPAPP-A seems to be superior as a prognostic marker compared to TPAPP-A, giving independent and additive prognostic information when measured at the time of admission in patients hospitalized for non-ST-elevation ACS.
Juha Lund; Saara Wittfooth; Qiu-Ping Qin; Tuomo Ilva; Pekka Porela; Kari Pulkki; Kim Pettersson; Liisa-Maria Voipio-Pulkki
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Publication Detail:
Type:  Journal Article     Date:  2010-05-06
Journal Detail:
Title:  Clinical chemistry     Volume:  56     ISSN:  1530-8561     ISO Abbreviation:  Clin. Chem.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-29     Completed Date:  2010-07-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421549     Medline TA:  Clin Chem     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1158-65     Citation Subset:  IM    
Department of Medicine, University of Turku, Turku, Finland.
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MeSH Terms
Acute Coronary Syndrome / blood,  diagnosis*,  mortality
Biological Markers / blood
Eosinophil Major Basic Protein / blood
Middle Aged
Myocardial Infarction / diagnosis,  mortality
Pregnancy-Associated Plasma Protein-A / analysis*
Protein Subunits / blood
Reg. No./Substance:
0/Biological Markers; 0/Protein Subunits; EC 3.1.27.-/Eosinophil Major Basic Protein; EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A

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