Pregnancy-associated plasma protein-a, a marker for outcome in patients suspected for acute coronary syndrome

ObjectivesTo examine if pregnancy-associated plasma protein-A (PAPP-A) in patients with chest pain, could identify patients at risk for death or myocardial infarction.Design and methodsPatients admitted with chest pain and both normal ECG and normal biomarkers were evaluated by serial measurement of PAPP-A. Main outcome measures were mortality and non-fatal myocardial infarction.ResultsMedian age of patients included (415) was 67 years and 43% were women. The risk of death or non-fatal myocardial infarction after 3 months was 15% in the highest quartile of circulating PAPP-A compared with 3% in the lowest quartile (relative risk 3.7, p < 0.01). Corresponding numbers after 1 year were 24% and 10% (relative risk 2.4, p = 0.01).ConclusionIn patients admitted with chest pain and both normal ECG and normal biomarkers PAPP-A seems to be valuable for predicting patients at high risk of death or non-fatal myocardial infarction.