Study Of Clinical Relativity Between Pregnancy Plasma Protein A And Acute Coronary Syndrome

Objective: Circulating markers indicating the instability of atherosclerotic plaques could have diagnostic value in unstable angina or acute myocardial infarction. We evaluated pregnancy-associated plasma protein A (PAPP-A), a potentially proatherosclerotic metalloproteinase, as a maker of acute coronary syndrome.Methods: We measured circulating levels of PAPP-A, C reactive protein in 22 patients with acute myocardial infarction, 18 patients with unstable angina pectoris, 20 patients with stable angina pectoris and another 20 controls. Data on PAPP-A and CRP, which were not distributed normally, were summarized by median and range and were compared among the groups with use of the Kruskal-Wallis test. When the results indicated that there were significant differences between groups, we made pairwise group comparisons using the Wilcoxon rank-sum statistic. Associations among circulating levels of these proteins were assessed by multiple regression. We used receiver-operating-characteristic (ROC) analysis on the levels of PAPP-A and CRP for ACS.Results: The median PAPP-A and CRP levels in control subjects were not significant different from those in patients with stable angina. In the group of patients with unstable angina, the median PAPP-A and CRP levels were significantly higher than those in the control group or the group with stable angina. In the group of patients with myocardial infarction, the median PAPP-Aand CRP levels were also significantly higher than those in the control group. The PAPP-A and CRP levels did not differ significantly between the group with unstable angina and the group with myocardial infarction. The level of CRP were significant associated with the PAPP-A level in patients with ACS. We examined the levels of CK-MB and TNT in patients with acute coronary syndrome, we found no significant association between the levels of PAPP-A and the level of either TNT or CK-MB. The area under the ROC curve for PAPP-A was 0.868 + 0.055, for CRP was 0.77 + 0.055, it suggest that PAPP-A is a valuable marker, better than CRP for identification of patients with ACS.Conclusion: PAPP-A is not produced in response to myocardial necrosis. It is a new maker for the early diagnosis of acute coronary syndromes better than CRP. Circulating PAPP-A levels can identify patients early in the process of plaque instability, when it might be possible to indicate myocardial injury.