TY - JOUR
T1 - Pregnancy-associated plasma protein A values in patients with stable cardiovascular disease
T2 - Use of a new monoclonal antibody-based assay
AU - Schulz, Olaf
AU - Reinicke, Markus
AU - Krämer, Jochen
AU - Berghöfer, Gunnar
AU - Bensch, Ricarda
AU - Schimke, Ingolf
AU - Jaffe, Allan
PY - 2011/5/12
Y1 - 2011/5/12
N2 - Background: PAPP-A is promising in improving risk stratification and invasive treatment decisions in stable cardiovascular patients. We evaluated the prognostic value of pregnancy-associated plasma protein A (PAPP-A) measured by a novel assay in stable cardiovascular patients. Methods: We investigated 228 stable cardiovascular outpatients. Blood was drawn for PAPP-A measurement after echocardiography and ergometry prior to heart catheterization. Angiographically we determined severity as well as qualitative characteristics suspect for vulnerability of coronary lesions. After 1108 ± 297. days, follow-up information was obtained by questionnaire mailings and interviews by phone. Results: 104 patients had coronary stenosis ≥ 70%, 75 had B-type lesions ≥ 50%, 46 showed complex lesions, and 68 were suspected to have vulnerable lesions. Median PAPP-A was 1.76 (interquartile range 1.21, 2.63) μIU/ml in the entire cohort. PAPP-A concentrations did not differ in dependence on coronary artery findings. A cutpoint of 2.7. μIU/ml was derived from receiver-operator characteristics for outcome measures. For this cutoff, Cox proportional hazard models with 19 further clinical variables showed that PAPP-A was predictive for all-cause death (HR 4.73, 95% CI 1.46-15.31, p = 0.01), all-cause death or nonfatal infarction (HR 4.01, 95% CI 1.58-10.13, p = 0.003) and all-cause death, nonfatal myocardial infarction or hospitalization (HR 1.96, 95% CI 1.03-3.70, p = 0.04). The predictive value of PAPP-A did not change substantially after correction for values of cardiac troponin, using a highly sensitive cardiac troponin I research assay. Conclusions: PAPP-A, measured by a new, monoclonal antibody-based assay is a promising prognostic marker in patients with stable cardiovascular disease and an indication for heart catheterization.
AB - Background: PAPP-A is promising in improving risk stratification and invasive treatment decisions in stable cardiovascular patients. We evaluated the prognostic value of pregnancy-associated plasma protein A (PAPP-A) measured by a novel assay in stable cardiovascular patients. Methods: We investigated 228 stable cardiovascular outpatients. Blood was drawn for PAPP-A measurement after echocardiography and ergometry prior to heart catheterization. Angiographically we determined severity as well as qualitative characteristics suspect for vulnerability of coronary lesions. After 1108 ± 297. days, follow-up information was obtained by questionnaire mailings and interviews by phone. Results: 104 patients had coronary stenosis ≥ 70%, 75 had B-type lesions ≥ 50%, 46 showed complex lesions, and 68 were suspected to have vulnerable lesions. Median PAPP-A was 1.76 (interquartile range 1.21, 2.63) μIU/ml in the entire cohort. PAPP-A concentrations did not differ in dependence on coronary artery findings. A cutpoint of 2.7. μIU/ml was derived from receiver-operator characteristics for outcome measures. For this cutoff, Cox proportional hazard models with 19 further clinical variables showed that PAPP-A was predictive for all-cause death (HR 4.73, 95% CI 1.46-15.31, p = 0.01), all-cause death or nonfatal infarction (HR 4.01, 95% CI 1.58-10.13, p = 0.003) and all-cause death, nonfatal myocardial infarction or hospitalization (HR 1.96, 95% CI 1.03-3.70, p = 0.04). The predictive value of PAPP-A did not change substantially after correction for values of cardiac troponin, using a highly sensitive cardiac troponin I research assay. Conclusions: PAPP-A, measured by a new, monoclonal antibody-based assay is a promising prognostic marker in patients with stable cardiovascular disease and an indication for heart catheterization.
KW - PAPP-A
KW - Prognosis
KW - Stable cardiovascular disease
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U2 - 10.1016/j.cca.2011.01.009
DO - 10.1016/j.cca.2011.01.009
M3 - Article
C2 - 21238442
AN - SCOPUS:79954989606
SN - 0009-8981
VL - 412
SP - 880
EP - 886
JO - Clinica Chimica Acta
JF - Clinica Chimica Acta
IS - 11-12
ER -