The utility of pregnancy-associated plasma protein A for determination of prognosis in a cohort of patients with coronary artery disease

Background: Pregnancy-associated plasma protein-A (PAPP-A) is discussed as a biomarker representing unstable plaques in coronary artery disease (CAD). Methods: In this study 927 patients with CAD (534 with stable angina and 393 with acute coronary syndrome [ACS]) and 217 patients without CAD and measured PAPP-A levels were included. Follow-up for a median of 5 years was documented. Results: Rising quartiles of PAPP-A concentration had a higher cardiovascular mortality in the overall cohort of patients with CAD (p = 0.002) and the cohort with ACS (p = 0.01). Patients with suspected ACS below the LOD for troponin I but elevated PAPP-A levels had an increased cardiovascular mortality. A cut-off of 11.4 IU/l identified patients with a higher mortality during follow-up. Conclusion: Rising PAPP-A levels are prognostic in patients with CAD. PAPP-A levels were especially predictive in ACS patients with troponin below 10% CV of the 99th percentile for cardiovascular mortality.