Evaluating the Role of Pregnancy-Associated Plasma Protein-A (PAPP-A) in Risk Stratification of NSTE-ACS Patients
Keywords:
Pregnancy-Associated Plasma Protein-A, non-ST segment elevation acute coronary syndrome, TIMI scoreAbstract
Objective: The primary objective of this study is to evaluate the association between serum Pregnancy-Associated Plasma Protein-A (PAPP-A) levels and the severity of atherosclerosis in patients with Non-ST Segment Elevation Acute Coronary Syndrome (NSTE-ACS), using TIMI risk stratification scores as a clinical assessment tool.
Methods: 100 diagnosed patients of NSTE-ACS who underwent coronary angiography were enrolled. The measurements of serum PAPP-A and other laboratory indices were performed within 24 hours after admission. Plasma PAPP-A levels were measured in all patients using the sandwich ELISA method. Patients were stratified based on TIMI risk score (0-7 scale) into low (0–2), intermediate (3–4), and high (5–7) risk groups to assess the association between PAPP-A levels and atherosclerotic severity.
Results: Mean serum PAPP-A levels of low-risk patients were (7.47±8.46) followed by high-risk group (7.29±9.23) and medium risk group (6.02±9.13). When statistically analyzed, all risk categories were found similar with respect to serum PAPP-A levels. (P=0.738) The ROC curve analysis for PAPP-A showed an Area Under the Curve (AUC) of 0.521, with a 95% confidence interval of 0.419 to 0.622 (P = 0.7919), indicating poor discriminatory ability. The optimal cut-off value was >2.0 µg/ml, corresponding to the highest Youden index. At this threshold, PAPP-A had a sensitivity of 66.67% (95% CI: 38.4 - 88.2%) and a specificity of 49.41% (95% CI: 38.4 - 60.5%). The positive likelihood ratio (+LR) was 1.32 (95% CI: 0.9 - 2.0) and the negative likelihood ratio (-LR) was 0.67 (95% CI: 0.3 - 1.4).
Conclusion: PAPP-A alone does not offer meaningful risk stratification in NSTE-ACS. Further research is warranted to evaluate its value in combination with other markers or scoring systems.
Downloads
References
Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation. 2016 Apr 19;133(16):1605-20.
Kipshidze N, Fareed J, Serruys PW, Moses J, editors. Textbook of interventional cardiovascular pharmacology. CRC Press; 2007 Jun 1.
Rodriguez F, Mahaffey KW. Management of patients with NSTE-ACS: a comparison of the recent AHA/ACC and ESC guidelines. Journal of the American College of Cardiology. 2016 Jul 19;68(3):313-21.
Chioncel O, Benson L, Crespo-Leiro MG, Anker SD, Coats AJ, Filippatos G, McDonagh T, Margineanu C, Mebazaa A, Metra M, Piepoli MF. Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry. European Journal of Preventive Cardiology. 2023 Sep;30(13):1346-58.
Thorn EM, Khan IA. Pregnancy associated plasma protein-A: an emerging cardiac biomarker. Int J Cardiol 2007;117:370–2.
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.
Consuegra-Sanchez L, Fredericks S, Kaski JC. Pregnancy-associated plasma protein-A (PAPP-A) and cardiovascular risk. Atheroscle rosis 2009;203:346–52.
Bayes-Genis A, Conover CA, Overgaard MT, et al. Pregnancy associated plasma protein-A as a marker of acute coronary syn dromes. N Engl J Med 2001;345:1022–9.
Lund J, Qin QP, Ilva T, et al. Circulating pregnancy-associated plasma protein A predicts outcome in patients with acute coro nary syndrome but no troponin I elevation. Circulation 2003; 108:1924–6.
Heeschen C, Dimmeler S, Hamm CW, Fichtlscherer S, Simoons ML, Zeiher AM. Pregnancy associated plasma protein-A levels in patients with acute coronary syndrome: comparison with mark ers of systemic, inflammation, platelet activation and myocardial necrosis. J Am Coll Cardiol 2005;45:229–37.
Iversen KK, Teisner AS, Teisner B, et al. Pregnancy-associated plasma protein A, a novel, quick and sensitive marker in ST segment myocardial infraction. Am J Cardiol 2008;101:1389–94.
Priya Gururajan, Prema Gurumurthy, Nayar P, Srinivasa G, R. Sai Babu, A. Sarasabharati, et al. Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome. Indian Heart Journal. 2012 Mar 1;64(2):141–5.
Laterza OF, Cameron SJ, Chappell D, Sokoll LJ, Green GB. Evaluation of pregnancy-associated plasma protein A as a prog nostic indicator in acute coronary syndrome patients. Clin Chim Acta 2004;348:163–9.
Lund J, Qin Q, Ilva T, Nikus K, Eskola M, Porela P, et al. Pregnancy‐associated plasma protein A: A biomarker in acute ST‐elevation myocardial infarction (STEMI). Annals of Medicine. 2006 Jan;38(3):221–8.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
