Pregnancy-Associated Plasma Protein-A Levels and Coronary Angiographic Features in Acute Coronary Syndrome Patients

Background . Pregnancy-associated plasma protein-A (PAPP-A) is a biomarker of plaque rupture, associated with adverse cardiac events in acute coronary syndromes (ACSs) patients. Aim . To identify coronary angiographic (CA) features related to PAPP-A level elevation in ACSs patients. Methods . Forty ACSs patients were enrolled in this prospective cohort study (level of evidence: III-prognostic). Serum samples for PAPP-A quantitation were obtained upon coronary care unit admission. All patients underwent CA and coronary intervention within 6 hours of sampling. Results . Mean age of the study cohort was 57 ± 11 years, (males: 55%, n=22). Patients with ST-segment elevation myocardial infarction (35%, n=14) showed significantly higher serum PAPP-A level (11.8 ± 2 µ g/mL), compared to non-ST-segment elevation myocardial infarction (15%, n=6) and unstable angina (50%, n=20) patients (11 ± 2.6 µ g/mL and 8.7 ± 2.3 µ g/mL, resp., P<0.001). Higher PAPP-A levels were significantly associated with complex culprit lesion morphology (11.8 ± 2 µ g/mL for type C lesions, 9.7± 2.5 µ g/mL and 7.3 ± 3.5 µ g/mL for type B and type A lesions, resp., P<0.001), while no relationship to number of diseased coronaries. Conclusion . Higher PAPP-A levels in ACSs patients are associated with unfavorable coronary anatomy and complex angiographic plaque features.