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Pregnancy Associated Plasma Protein-A (PAPP-A) Levels in Acute Coronary Syndrome: A Case Control Study in a Tertiary Care Centre

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Abstract

In recent years, an important objective of cardiovascular research has been to find new markers that would improve the risk stratification and diagnosis of patients presenting with symptoms of acute coronary syndrome (ACS). Established biomarkers for diagnosis of ACS includes troponins and creatine kinase MB (CK-MB). Pregnancy associated plasma protein A (PAPP-A) is an emerging marker which has been described as a marker of plaque instability. PAPP-A is a large metalloproteinase involved in insulin-like growth factor signaling and has been shown to be involved in pathological processes like atherosclerosis. Many studies have been published regarding release of PAPP-A in circulation during ACS. The objective of this study was to evaluate the role of PAPP-A as an early marker of ACS by comparing levels of PAPP-A in patients with acute myocardial infarction (AMI) and unstable angina (UA) with asymptomatic controls. The association of PAPP-A with markers of myocardial necrosis and the association of PAPP-A levels to the presence of risk factors for coronary artery disease was also studied. We measured PAPP-A levels in patients with AMI (30), UA (23) and asymptomatic controls (45). PAPP-A was estimated using PAPP-A US (ultra sensitive) ELISA manufactured by DRG (Germany). PAPP-A levels were significantly elevated in patients with AMI and in patients with UA (mean levels 64.26 ± 1.05 and 36.23 ± 1.05 ng/ml respectively; p < 0.001). Mean PAPP-A levels in controls were 10.68 ± 1.04 ng/ml. In UA cases PAPP-A levels were elevated when the troponin I and CK-MB levels were within the normal range. No correlation was observed between PAPP-A with markers of myocardial necrosis. PAPP-A can serve as a useful biomarker in the diagnosis of ACS, especially UA, where cardiac troponin levels and CK-MB levels are not elevated and ECG changes are inconclusive.

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References

  1. Thorn Eric M, Khan Ijaz A. Pregnancy associated plasma protein-a: an emerging cardiac biomarker. Int J Cardiol. 2007;117:370–2.

    Article  PubMed  Google Scholar 

  2. Li X, Liu Q, Zhou T, Zhou S, Shou S. PAPP-A: a possible pathogenic link to the instability of atherosclerotic plaque. Med Hypotheses. 2008;70:597–9.

    Article  CAS  PubMed  Google Scholar 

  3. Consuegra-Sanchez L, Fredericks S, Kaski JC. Pregnancy associated plasma protein-A (PAPP-A) and cardiovascular risk. Atherosclerosis. 2009;203:346–52.

    Article  CAS  PubMed  Google Scholar 

  4. Bayes-Genis A, Conover CA, Overgaard MT, Bailey KR, Christiansen M, Holmes DR, Virmani R, Oxvig C, Schwartz RS. Pregnancy associated plasma protein a as a marker of acute coronary syndromes. N Engl J Med. 2001;345:1022–9.

    Article  CAS  PubMed  Google Scholar 

  5. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.

    Article  CAS  PubMed  Google Scholar 

  6. Fuster V, Badimon J, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and acute coronary syndromes. N Engl J Med. 1992;326:310–8.

    Article  CAS  PubMed  Google Scholar 

  7. Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007;29(386):1–32.

    Google Scholar 

  8. Heeschen C, Dimmeler S, Hamm CW, Fichtlscherer S, Simoons ML, Zeiher AM. Pregnancy-associated plasma protein-A levels in patients with acute coronary syndromes: comparison with markers of systemic inflammation, platelet activation, and myocardial necrosis. J Am Coll Cardiol. 2005;45(2):229–37.

    Article  CAS  PubMed  Google Scholar 

  9. Iversen KK, Dalsgaard M, Teisner AS, Schoos M, Teisner B, Nielsen H, Clemmensen P, Grande P. Usefulness of PAPP-A in patients with acute coronary syndrome. Am J Cardiol. 2009;104:1465–71.

    Article  CAS  PubMed  Google Scholar 

  10. Elesber AA, Conover CA, Denktas AE, Lennon RJ, Holmes DR Jr, Overgaard MT, Christiansen M, Oxvig C, Lerman LO, Lerman A. Prognostic value of circulating pregnancy associated plasma protein A levels in patients with chronic stable angina. Eur Heart J. 2006;27(14):1678–84.

    Article  CAS  PubMed  Google Scholar 

  11. Mahto Sunita, Sharma SB, Dwivedi S, Puri D, Tripathi RL. Biomarkers for early detection of risk in female patients with coronary artery disease: pilot study. JAPI. 2013;61:317–9.

    PubMed  Google Scholar 

  12. Lund J, Qin QP, Ilva T, Pettersson K, Voipio-Pulkki LM, Porela P, Pulkki K. Circulating pregnancy associated plasma protein a predicts outcome in patients with acute coronary syndrome but no troponin I elevation. Circulation. 2003;108:1924–6.

    Article  PubMed  Google Scholar 

  13. Gururajan P, Gurumurthy P, Nayar P, Nageswara Rao GS, Babu RS, Sarasabharati A, Cherian KM. Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome. Indian Heart J. 2012;64(2):141–5.

    Article  PubMed Central  PubMed  Google Scholar 

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  1. Department of Biochemistry, Amrita School of Medicine, Amrita Institute of Medical Science, Amrita Vishwa Vidyapeetham, Kochi, India

    Nazia Parveen, K. N. Subhakumari & Sajitha Krishnan

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  1. Nazia Parveen
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  2. K. N. Subhakumari
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  3. Sajitha Krishnan
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Correspondence to Nazia Parveen.

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Parveen, N., Subhakumari, K.N. & Krishnan, S. Pregnancy Associated Plasma Protein-A (PAPP-A) Levels in Acute Coronary Syndrome: A Case Control Study in a Tertiary Care Centre. Ind J Clin Biochem 30, 150–154 (2015). https://doi.org/10.1007/s12291-014-0421-9

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  • DOI: https://doi.org/10.1007/s12291-014-0421-9

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