Evaluation of pregnancy-associated plasma protein A as a prognostic indicator in acute coronary syndrome patients

Omar F. Laterza, Scott J. Cameron, Derek Chappell, Lori J. Sokoll, Gary B. Green

Research output: Contribution to journalArticlepeer-review


Background: Higher circulating concentrations of pregnancy-associated plasma protein A (PAPP-A), a potential proatherosclerotic metalloproteinase, have been associated with increased risk for acute coronary syndrome (ACS). Our goal was to determine the ability of circulating concentrations of PAPP-A to predict adverse events in patients presenting to the Emergency Department (ED) with symptoms of ACS. Methods: A total of 346 patients with symptoms of ACS were included in the study. Serum samples obtained immediately after enrollment were analyzed for PAPP-A and cardiac troponin T (cTnT). The occurrence of adverse events during a 30-day follow-up period was recorded, and receiver-operating characteristic (ROC) curve analysis was performed to evaluate the prognostic characteristics of PAPP-A and cTnT. Results: A total of 33 (9.5 %) patients developed adverse events during the follow up period. At a cut-off concentration of 0.22 mIU/l, PAPP-A was a predictor of adverse events with a sensitivity and specificity (95% C.I.) of 66.7% (48.2-82.0) and 51.1% (45.4-56.8), respectively. The sensitivity and specificity of cTnT were 51.5% (33.6-69.2) and 82.1% (77.4-86.2), respectively, using a 0.01-ng/ml cut-off value, which was obtained using ROC analysis. Conclusions: PAPP-A appears to be a modest predictor of adverse events in patients presenting to the ED with ACS symptoms, being inferior to cTnT in predicting adverse events in an ED setting. PAPP-A appears to be as sensitive as cTnT, but it is less specific.

Original languageEnglish (US)
Pages (from-to)163-169
Number of pages7
JournalClinica Chimica Acta
Issue number1-2
StatePublished - Oct 1 2004


  • Acute coronary syndrome
  • Adverse events
  • PAPP-A
  • cTnT

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Biochemistry, medical

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