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Elevated PAPP-A sets alarm bells ringing in patients with cardiac chest pain

Goran Loncar1, Stephan von Haehling

  • 1Cardiology Department, Zvezdara University Medical Center, Belgrade, Serbia.

Expert Review of Cardiovascular Therapy
|December 12, 2013
PubMed

Insights

Elevated pregnancy-associated plasma protein A (PAPP-A) levels in cardiac chest pain patients signal a fivefold increased risk of adverse cardiovascular events within 90 days. This novel marker offers prognostic value beyond traditional risk factors.

Area of Science:

  • Cardiovascular Research
  • Biochemical Markers
  • Prognostic Indicators

Background:

  • Novel biochemical markers are crucial for refining risk assessment in patients prone to adverse cardiac events.
  • Pregnancy-associated plasma protein A (PAPP-A) is emerging as a significant prognostic marker, independent of conventional risk factors.
  • PAPP-A is increasingly recognized for its role in indicating plaque destabilization within cardiovascular research.

Discussion:

  • Higher serum PAPP-A levels (>34.6 mIU/l) in cardiac chest pain patients are independently linked to a significantly increased short-term risk of cardiovascular events.
  • These events include myocardial infarction, ischemic stroke, stent thrombosis, and cardiovascular-related death within 90 days.
  • Patients with PAPP-A levels above the threshold face a fivefold higher frequency of adverse cardiovascular events compared to those with lower levels.

Key Insights:

  • Serum PAPP-A >34.6 mIU/l serves as a critical warning for heightened short-term cardiovascular event risk in chest pain patients.
  • The prognostic information provided by PAPP-A is independent of traditional cardiovascular risk factors.
  • A hazard ratio of 5.28 (95% CI: 3.81-7.31) underscores the substantial risk associated with elevated PAPP-A levels.

Outlook:

  • Current evidence does not support PAPP-A as a diagnostic tool for acute coronary syndrome, especially when compared to troponin.
  • PAPP-A's interaction with heparin may limit its practical clinical application.
  • Further large-scale, multicenter studies are essential to validate PAPP-A's utility in routine clinical practice for cardiovascular risk stratification.

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