European Heart Journal Advance Access originally published online on May 22, 2006
European Heart Journal 2006 27(14):1678-1684; doi:10.1093/eurheartj/ehl042
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Prognostic value of circulating pregnancy-associated plasma protein levels in patients with chronic stable angina
1 Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
2 Endocrine Research Unit, Mayo Clinic College of Medicine, Rochester, MN, USA
3 Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA
4 Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, MN, USA
5 Department of Molecular Biology, University of Aarhus, Aarhus, Denmark
6 Department of Clinical Biochemistry, Statens Serum Institute, Copenhagen, Denmark
Received 20 December 2005; revised 16 March 2006; accepted 4 May 2006; online publish-ahead-of-print 22 May 2006.
* Corresponding author. Tel: +1 507 284 2511; fax: +1 507 255 2550. E-mail address: lerman.amir{at}mayo.edu
See page 1637 for the editorial comment on this article (doi:10.1093/eurheartj/ehl118)
Aims Unstable coronary atherosclerotic plaque can be present in patients with chronic stable coronary artery disease (CAD). Our objective was to assess whether measurement of plasma pregnancy-associated plasma protein (PAPP-A) level, a reflection of plaque instability, in patients with chronic stable CAD had an independent prognostic value on the subsequent incidence of death, acute coronary syndrome (ACS), and revascularization.
Methods and results Patients referred for coronary angiography were recruited. A cohort of 103 patients with stable symptoms for at least 6 weeks and with a coronary angiogram showing at least a 50% luminal diameter narrowing formed our study population. Median follow-up was 4.9 years. Mean age was 65±10 years. In a multivariable model that included CAD traditional risk factors, ejection fraction, extent of coronary atherosclerosis, prior history of myocardial infarction, prior revascularization, discharge medications, and C-reactive protein, the plasma PAPP-A was found to be significantly associated with the endpoint of future death [adjusted hazard ratio (HR) 5.29; 95% CI 1.27–22.0; P=0.023] and with the endpoint of future death and ACS (adjusted HR 3.56; 95% CI 1.27–10.0; P=0.015), but not with the endpoint of future death and revascularization.
Conclusion Measurement of plasma PAPP-A level in patients with chronic stable CAD has an independent prognostic value on the occurrence of death and ACS.
Key Words: Pregnancy-associated plasma protein • Stable coronary artery disease • Unstable atherosclerotic coronary plaque
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