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Pregnancy-associated plasma protein A as a marker of acute coronary syndromes.
N Engl J Med. 2001 Oct 04; 345(14):1022-9.NEJM

Abstract

BACKGROUND

Circulating markers indicating the instability of atherosclerotic plaques could have diagnostic value in unstable angina or acute myocardial infarction. We evaluated pregnancy-associated plasma protein A (PAPP-A), a potentially proatherosclerotic metalloproteinase, as a marker of acute coronary syndromes.

METHODS

We examined the level of expression of PAPP-A in eight culprit unstable coronary plaques and four stable plaques from eight patients who had died suddenly of cardiac causes. We also measured circulating levels of PAPP-A, C-reactive protein, and insulin-like growth factor I (IGF-I) in 17 patients with acute myocardial infarction, 20 with unstable angina, 19 with stable angina, and 13 controls without atherosclerosis.

RESULTS

PAPP-A was abundantly expressed in plaque cells and extracellular matrix of ruptured and eroded unstable plaques, but not in stable plaques. Circulating PAPP-A levels were significantly higher in patients with unstable angina or acute myocardial infarction than in patients with stable angina and controls (P<0.001). A PAPP-A threshold value of 10 mlU per liter identified patients who had acute coronary syndromes with a sensitivity of 89.2 percent and a specificity of 81.3 percent. PAPP-A levels correlated with levels of C-reactive protein and free IGF-I, but not with markers of myocardial injury (troponin I and the MB isoform of creatine kinase).

CONCLUSIONS

PAPP-A is present in unstable plaques, and circulating levels are elevated in acute coronary syndromes; these increased levels may reflect the instability of atherosclerotic plaques. PAPP-A is a new candidate marker of unstable angina and acute myocardial infarction.

Authors+Show Affiliations

Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

11586954

Citation

Bayes-Genis, A, et al. "Pregnancy-associated Plasma Protein a as a Marker of Acute Coronary Syndromes." The New England Journal of Medicine, vol. 345, no. 14, 2001, pp. 1022-9.
Bayes-Genis A, Conover CA, Overgaard MT, et al. Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. N Engl J Med. 2001;345(14):1022-9.
Bayes-Genis, A., Conover, C. A., Overgaard, M. T., Bailey, K. R., Christiansen, M., Holmes, D. R., Virmani, R., Oxvig, C., & Schwartz, R. S. (2001). Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. The New England Journal of Medicine, 345(14), 1022-9.
Bayes-Genis A, et al. Pregnancy-associated Plasma Protein a as a Marker of Acute Coronary Syndromes. N Engl J Med. 2001 Oct 4;345(14):1022-9. PubMed PMID: 11586954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. AU - Bayes-Genis,A, AU - Conover,C A, AU - Overgaard,M T, AU - Bailey,K R, AU - Christiansen,M, AU - Holmes,D R,Jr AU - Virmani,R, AU - Oxvig,C, AU - Schwartz,R S, PY - 2001/10/6/pubmed PY - 2001/10/12/medline PY - 2001/10/6/entrez SP - 1022 EP - 9 JF - The New England journal of medicine JO - N Engl J Med VL - 345 IS - 14 N2 - BACKGROUND: Circulating markers indicating the instability of atherosclerotic plaques could have diagnostic value in unstable angina or acute myocardial infarction. We evaluated pregnancy-associated plasma protein A (PAPP-A), a potentially proatherosclerotic metalloproteinase, as a marker of acute coronary syndromes. METHODS: We examined the level of expression of PAPP-A in eight culprit unstable coronary plaques and four stable plaques from eight patients who had died suddenly of cardiac causes. We also measured circulating levels of PAPP-A, C-reactive protein, and insulin-like growth factor I (IGF-I) in 17 patients with acute myocardial infarction, 20 with unstable angina, 19 with stable angina, and 13 controls without atherosclerosis. RESULTS: PAPP-A was abundantly expressed in plaque cells and extracellular matrix of ruptured and eroded unstable plaques, but not in stable plaques. Circulating PAPP-A levels were significantly higher in patients with unstable angina or acute myocardial infarction than in patients with stable angina and controls (P<0.001). A PAPP-A threshold value of 10 mlU per liter identified patients who had acute coronary syndromes with a sensitivity of 89.2 percent and a specificity of 81.3 percent. PAPP-A levels correlated with levels of C-reactive protein and free IGF-I, but not with markers of myocardial injury (troponin I and the MB isoform of creatine kinase). CONCLUSIONS: PAPP-A is present in unstable plaques, and circulating levels are elevated in acute coronary syndromes; these increased levels may reflect the instability of atherosclerotic plaques. PAPP-A is a new candidate marker of unstable angina and acute myocardial infarction. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/11586954/Pregnancy_associated_plasma_protein_A_as_a_marker_of_acute_coronary_syndromes_ L2 - https://www.nejm.org/doi/10.1056/NEJMoa003147?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -