Article

Journal of Thrombosis and Thrombolysis

, Volume 34, Issue 1, pp 99-105

First online:

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

  • Petr HájekAffiliated withDepartment of Cardiology, Charles University and University Hospital Motol Email author 
  • , Milan MacekSr.Affiliated withDepartment of Biology and Medical Genetics, Charles University and University Hospital Motol
  • , Martina PeškováAffiliated withDepartment of Biology and Medical Genetics, Charles University and University Hospital Motol
  • , Marie HladíkováAffiliated withDepartment of Biology and Medical Genetics, Charles University and University Hospital Motol
  • , Eva HansvenclováAffiliated withDepartment of Cardiology, Charles University and University Hospital Motol
  • , Martin MalýAffiliated withDepartment of Cardiology, Charles University and University Hospital Motol
  • , Josef VeselkaAffiliated withDepartment of Cardiology, Charles University and University Hospital Motol
  • , Alice KrebsováAffiliated withDepartment of Internal Medicine/Cardiology, Virchow Klinikum, Humboldt University

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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 syndrome Pregnancy-associated plasma protein-A Troponin Diagnostic significance