Key result
In patients with cardiac chest pain, serum PAPP-A levels >34.6 mIU/l were associated with a significantly higher 90-day risk of adverse cardiovascular events (HR 5.28; 95% CI 3.81-7.31).
Why the study?
Does elevated serum PAPP-A (>34.6 mIU/l) predict short-term adverse cardiovascular events in patients presenting with cardiac chest pain?
Does elevated serum PAPP-A (>34.6 mIU/l) predict short-term adverse cardiovascular events in patients presenting with cardiac chest pain?
Hazard Ratio: 5.28 (95% CI 3.81–7.31)
Elevated PAPP-A (>34.6 mIU/l) is a strong independent predictor of short-term adverse cardiovascular events in patients with cardiac chest pain, though its clinical utility is limited by heparin interaction.
Elevated PAPP-A may aid short-term risk stratification in chest pain; leaves open clinical utility pending heparin-adjusted prospective validation.
Novel biochemical markers may improve the estimation of overall risk in subjects at a high risk of adverse cardiac events. Measurement of some of these markers, including pregnancy-associated plasma protein A (PAPP-A), brings significant prognostic information independent of traditional risk factors. PAPP-A has been recently identified as a marker of plaque destabilization with growing interest in cardiovascular research. Our group has recently demonstrated that higher levels of serum PAPP-A were independently associated with an increased short-term risk of cardiovascular events in a large sample of 2568 consecutive patients presenting with cardiac chest pain. PAPP-A levels above 34.6 mIU/l in cardiac chest-pain patients sets alarm bells ringing as a warning for higher risk of short-term cardiovascular adverse events, including stent thrombosis, myocardial infarction, ischemic stroke or cardiovascular-related death within 90 days, the combined primary end point of this study. Cardiac chest pain patients with PAPP-A levels above 34.6 mIU/l may suffer from adverse cardiovascular events five times more frequently within 90 days than those with lower PAPP-A levels (hazard ratio: 5.28; 95% CI: 3.81-7.31). However, current data do not support the diagnostic role of PAPP-A for acute coronary syndrome in comparison to the gold standard biomarker troponin. Additionally, PAPP-A is known to interact with heparin, which may diminish its potential utility in every day clinical life. Future multicenter and large-volume studies are warranted to validate the use of PAPP-A in routine clinical practice.
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Loncar et al. (2013) conducted a review in Cardiac chest pain (n=2,568). Serum PAPP-A levels > 34.6 mIU/l vs. Lower PAPP-A levels was evaluated on Combined primary end point of stent thrombosis, myocardial infarction, ischemic stroke or cardiovascular-related death within 90 days (HR 5.28, 95% CI 3.81-7.31). In patients with cardiac chest pain, serum PAPP-A levels >34.6 mIU/l were associated with a significantly higher 90-day risk of adverse cardiovascular events (HR 5.28; 95% CI 3.81-7.31).
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