Usefulness of pregnancy-associated plasma protein A in patients with acute coronary syndrome

TY - JOUR

T1 - Usefulness of pregnancy-associated plasma protein A in patients with acute coronary syndrome

AU - Iversen, Kasper K

AU - Dalsgaard, Morten

AU - Teisner, Ane S

AU - Schoos, Mikkel

AU - Teisner, Borge

AU - Nielsen, Henrik

AU - Clemmensen, Peter

AU - Grande, Peer

AU - Iversen, Kasper K

AU - Dalsgaard, Morten

AU - Teisner, Ane S

AU - Schoos, Mikkel

AU - Teisner, Borge

AU - Nielsen, Henrik

AU - Clemmensen, Peter

AU - Grande, Peer

N1 - Keywords: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Biological Markers; Denmark; Electrocardiography; Female; Hospitals, District; Hospitals, University; Humans; Incidence; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Odds Ratio; Predictive Value of Tests; Pregnancy; Pregnancy-Associated Plasma Protein-A; Prognosis; Prospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate Times Cited: 0ArticleEnglishIversen, K. KHillerod Hosp, Dept Cardiol, Hillerod, DenmarkCited References Count: 24531BKEXCERPTA MEDICA INC-ELSEVIER SCIENCE INC685 ROUTE 202-206 STE 3, BRIDGEWATER, NJ 08807 USABRIDGEWATER

PY - 2009

Y1 - 2009

N2 - To investigate whether pregnancy-associated plasma protein-A (PAPP-A) is a prognostic marker in patients admitted with high-risk acute coronary syndrome. In patients admitted with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and ST-segment elevation myocardial infarction (STEMI), risk stratification is primarily determined by the markers of myocardial necrosis and known demographic risk profiles. However, it has recently been proposed that the presence and extent of vulnerable plaques might influence the prognosis significantly. A marker for the vulnerable plaque could identify patients at high risk who would potentially benefit from intensive treatment and surveillance. Two populations of consecutive patients admitted with high-risk NSTE-ACS (n = 123) and STEMI (n = 314) were evaluated with serial measurements of PAPP-A. The incidence of mortality and nonfatal myocardial infarction was prospectively registered for 2.66 to 3.47 years. In the patients with high-risk NSTE-ACS, PAPP-A was related to the risk of nonfatal myocardial infarction (p = 0.02) and death (p = 0.03). This result was consistent on multivariate analysis of the combination of mortality or nonfatal myocardial infarction (odds ratio 2.65, 95% confidence interval 1.40 to 5.03) but not for mortality alone (p = NS). In patients with STEMI, PAPP-A was related to the risk of death (p = 0.01) but not the composite outcome of myocardial infarction and death. This was also true after adjustment for other univariate predictors of death (odds ratio 2.19, 95% confidence interval 1.16 to 4.16). In conclusion, PAPP-A seems to be valuable in predicting the outcomes of patients admitted with high-risk NSTE-ACS or STEMI.

AB - To investigate whether pregnancy-associated plasma protein-A (PAPP-A) is a prognostic marker in patients admitted with high-risk acute coronary syndrome. In patients admitted with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and ST-segment elevation myocardial infarction (STEMI), risk stratification is primarily determined by the markers of myocardial necrosis and known demographic risk profiles. However, it has recently been proposed that the presence and extent of vulnerable plaques might influence the prognosis significantly. A marker for the vulnerable plaque could identify patients at high risk who would potentially benefit from intensive treatment and surveillance. Two populations of consecutive patients admitted with high-risk NSTE-ACS (n = 123) and STEMI (n = 314) were evaluated with serial measurements of PAPP-A. The incidence of mortality and nonfatal myocardial infarction was prospectively registered for 2.66 to 3.47 years. In the patients with high-risk NSTE-ACS, PAPP-A was related to the risk of nonfatal myocardial infarction (p = 0.02) and death (p = 0.03). This result was consistent on multivariate analysis of the combination of mortality or nonfatal myocardial infarction (odds ratio 2.65, 95% confidence interval 1.40 to 5.03) but not for mortality alone (p = NS). In patients with STEMI, PAPP-A was related to the risk of death (p = 0.01) but not the composite outcome of myocardial infarction and death. This was also true after adjustment for other univariate predictors of death (odds ratio 2.19, 95% confidence interval 1.16 to 4.16). In conclusion, PAPP-A seems to be valuable in predicting the outcomes of patients admitted with high-risk NSTE-ACS or STEMI.

U2 - 10.1016/j.amjcard.2009.07.017

DO - 10.1016/j.amjcard.2009.07.017

M3 - Journal article

C2 - 19932776

SN - 0002-9149

VL - 104

SP - 1465

EP - 1471

JO - American Journal of Cardiology

JF - American Journal of Cardiology

IS - 11

ER -