Value of serum pregnancy-associated plasma protein A for predicting cardiovascular events among patients presenting with cardiac chest pain

gle cause of death in the Western world. Patients with coronary artery disease cycle between asymptomatic phases, episodes of progressive angina and acute coronary syndromes. Cardiac troponin levels have a high sensitivity and specificity in the diagnosis of non-STsegment elevation myocardial infarction. However, a large number of patients at risk of major coronary events do not present with myo cardial necrosis and cannot be identified by troponin elevations. Markers of plaque instability may be helpful in this regard. An interesting candidate for the identification of unstable plaques is the zinc-binding metalloproteinase pregnancy-associated plasma protein A (PAPP-A). It was identified in 1972 in blood samples from pregnant women, and it is widely used in the screening for fetal trisomy. However, the term “pregnancy-associated plasma protein A” is misleading, because the peptide is not secreted only during pregnancy. Interest in cardiovascular applications first arose in 2001, when it became clear that the peptide is abundantly expressed in eroded and ruptured, but not in stable, atherosclerotic plaques. Several authors have later pursued the idea that PAPP-A might help to stratify the risk of major adverse cardiovascular events in patients with coronary artery disease. However, earlier studies were limited by sample size or by the number of clinical events. We sought to evaluate the value of PAPP-A for predicting major adverse cardiovascular Value of serum pregnancy-associated plasma protein A for predicting cardiovascular events among patients presenting with cardiac chest pain