Key result
Elevated PAPP-A serum concentration (≥47.15 mIU/L) on admission was significantly associated with a higher risk of 12-month major adverse cardiovascular events compared to lower levels (71.4% vs 42.9%, p=0.03).
Why the study?
Does the measurement of serum PAPP-A concentration on admission improve the GRACE score stratification of 1-year cardiovascular risk in patients with suspected acute coronary syndrome?
Observational (n=70)
No
Does the measurement of serum PAPP-A concentration on admission improve the GRACE score stratification of 1-year cardiovascular risk in patients with suspected acute coronary syndrome?
While serum PAPP-A is a promising prognostic biomarker in suspected ACS, it does not improve the overall prognostic value of the GRACE score for 1-year mortality.
BACKGROUND: The Global Registry of Acute Coronary Events (GRACE) study produced a scale for risk stratification in acute coronary syndromes (ACSs). Pregnancy-associated plasma protein A (PAPP-A) serum concentration was implicated as a marker of unstable atherosclerotic plaques. OBJECTIVES: We hypothesized that the measurement of the concentration of PAPP-A on admission may improve the stratification of cardiovascular risk in suspected ACS patients. MATERIAL AND METHODS: We studied 70 patients with chest pain suggesting ACS diagnosis on admission. Serum cardiac biomarkers and PAPP-A were measured on top of the standard biochemical panel, and the GRACE risk score was calculated. A 12-month follow-up was completed to major adverse cardiac events (MACE): death, myocardial infarction (MI), need for percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG), unplanned cardiovascular hospitalization. RESULTS: In hospital/6-month GRACE, low risk was found in 35 patients (50%)/37 patients (53%), intermediate risk in 23 patients (33%)/21 patients (30%) and high risk in 12 patients (17%)/12 patients (17%). Mean PAPP-A was 39.64 mlU/L (standard deviation - SD 24.2), and median PAPP-A values for in hospital/6-month GRACE were 21.49 mlU/L (quartile 1st; 3rd - 13.41; 32.65) and 22.61 mlU/L (14.03; 34.1) for low risk patients, 51.76 mlU/L (35.18; 59.99) and 51.76 mlU/L (28.9; 62.1) for intermediate risk patients, and 68.82 mlU/L (58.54; 83.76) for high risk patients. The PAAP-A concentration with specific cut-off points had 66.7% positive predictive value (PPV) and 95.5% negative predictive value (NPV) for death, 33.3% PPV and 80.6% NPV for MI, 71.4% PPV and 57.1% NPV for any event. Intermediate and high in hospital/6-months GRACE had 14.3%/15.2% PPV and 100%/100% NPV for death, 34.3%/33.3% PPV and 94.3%/91.9% NPV for MI, 74.3%/72.7% PPV and 65.7%/62.2% NPV for any event. CONCLUSIONS: The PAPP-A serum concentration represents a promising prognostic biomarker with significantly improved PPV. The GRACE score is superior to stratification based on PAPP-A with regard to combined cut-off point for 1-year mortality.
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Ojrzanowski et al. (2018) conducted an observational in Suspected acute coronary syndrome (n=70). Elevated serum pregnancy-associated plasma protein A (PAPP-A) concentration vs. Lower PAPP-A concentration (<47.15 mIU/L) was evaluated on Major adverse cardiovascular events (MACE) at 12 months (p=0.03). Elevated PAPP-A serum concentration (≥47.15 mIU/L) on admission was significantly associated with a higher risk of 12-month major adverse cardiovascular events compared to lower levels (71.4% vs 42.9%, p=0.03).
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