Journal of Thrombosis and Thrombolysis

, Volume 34, Issue 1, pp 99–105

High positive predictive value of PAPP-A for acute coronary syndrome diagnosis in heparin-naïve patients

Authors

    • Department of CardiologyCharles University and University Hospital Motol
  • Milan MacekSr.
    • Department of Biology and Medical GeneticsCharles University and University Hospital Motol
  • Martina Pešková
    • Department of Biology and Medical GeneticsCharles University and University Hospital Motol
  • Marie Hladíková
    • Department of Biology and Medical GeneticsCharles University and University Hospital Motol
  • Eva Hansvenclová
    • Department of CardiologyCharles University and University Hospital Motol
  • Martin Malý
    • Department of CardiologyCharles University and University Hospital Motol
  • Josef Veselka
    • Department of CardiologyCharles University and University Hospital Motol
  • Alice Krebsová
    • Department of Internal Medicine/CardiologyVirchow Klinikum, Humboldt University
Article

DOI: 10.1007/s11239-012-0679-9

Cite this article as:
Hájek, P., Macek, M., Pešková, M. et al. J Thromb Thrombolysis (2012) 34: 99. doi:10.1007/s11239-012-0679-9

Abstract

Pregnancy-associated plasma protein-A (PAPP-A) was studied as a marker of acute coronary syndrome (ACS). It has been shown that its levels are increased by heparin administration. Therefore, the aim of our study was to ascertain the diagnostic significance of PAPP-A in heparin-naïve patients and compare it with (TnI). We prospectively studied 67 heparin-naïve patients with acute chest pain. The patients were independently grouped according to the presence or absence of ACS. PAPP-A levels were significantly increased in ACS patients (8.6 vs. 7.3 mIU/l; P = 0.006) with high positive (95.7%) and lower negative predictive values (47.7%). In multivariate analysis, its levels were strongly predictive of a final diagnosis of ACS (OR 41.8; 95th CI 2.64–662.6; P = 0.008). The diagnostic significance of PAPP-A was not higher than TnI even within 6 h after the onset of chest pain [the area under the ROC curve (AUC) was 0.69 for PAPP-A and 0.91 for TnI, respectively; P = 0.08]. We observed no difference in the AUC in NSTE-ACS patients (0.73 for PAPP-A and 0.79 for TnI (P = 0.5)). PAPP-A levels were an independent predictor of ACS diagnosis in heparin-naïve patients. Its diagnostic significance was not higher than TnI even within a short period after the onset of chest pain. In troponin-negative NSTE-ACS patients, PAPP-A helped make the correct final diagnosis.

Keywords

Acute coronary syndromePregnancy-associated plasma protein-ATroponinDiagnostic significance

Copyright information

© Springer Science+Business Media, LLC 2012