| Objective:To research the expression level of pregnancy associated plasma protein-A (PAPP-A) in patients with acute coronary syndrome (ACS), and explore its early diagnosis and prognosis evaluation value for ACS patients.Methods:one hundred and seventy-six hospitalized patients were enrolled in the research, excluding of hepatic and renal insufficiency, acute infectious disease, tumor, pregnancy, rheumatoid disease, severe heart failure and a history of trauma or surgery within the previous month. We divided the participants into ACS group (n=110), SAP group (n=36) and NC group (n=30); By clinical conditions, we also divided ACS patients into AMI group (n=60) and UAP group (n=50); Basis of coronary lesions, the participants were divided into Jenkins scores≤10 group and Jenkins scores>10 group. All the selected patients were detected admission PAPP-A, myocardial enzymes, cTnI leves and fasting lipid, glucose, hs-CRP leves; fasting PAPP-A was added for ACS patients. Echocardiography was conducted within 1 week to compute ventricular diameter, E/A ratio, LVEF. We compared the PAPP-A concentration, other serum biochemical indicators, echocardiography indexes for each group. The analysis of correlation relationship between PAPP-A and hs-CRP, Jenkins scores were included in this study. We explored the PAPP-A's diagnostic value for ACS, UAP and AMI patients. The happening of various clinical events (cardiovascular death, revascularization, hospitalization for UAP, heart failure, stroke) within six months was recorded to explore the PAPP-A's prognostic value for ACS, UAP+NSTEMI and AMI patients (at the cut-off of 0.9mIU/L).Results:1. ACS group's PAPP-A level was obviously higher than NC group (1.11±5.68mIU/L vs 0.63±2.61mIU/L, p<0.05), SAP group's PAPP-A level (0.69±2.13mlU/L) was between the former two groups, but had no significantly differences with them. ACS group's LVDd, LVDs were larger than NC group; LVEF, TC, HDLc was lower than NC group; GLU, CK, CK-MB and cTnI were all higher than SAP group and NC group respectively.2. AMI group's E/A ratio, GLU, CK, CK-MB, cTnl and hs-CRP were all higher than UAP group; while LVEF value, TG and PAPP-A level (0.68±1.41mIU/L vs 4.20±10.00mIU/L, p=0.000) were much lower.3. Between the two different Jenkins scores groups, no statistic difference of PAPP-A levels was found.4. No significantly correlation was found between PAPP-A and the Jenkins scores (r=0.016, p=0.857), hs-CRP (r=0.035, p=0.651).5. The AUCROC of PAPP-A for ACS patients was 61.1%, it was lower than CK, CK-MB and cTnl; while for UAP patients, the AUCROC was 71.3%, that was clearly higher than those indicators of myocardial necrosis; the AUCROC for AMI patients was only 42.3%.6. After 6 months follow-up, the PAPP-A>0.9mIU/L group's incidence of various clinical end events was evidently higher than PAPP-A≤0.9mIU/L group. Its risk ratio of predicting clinical end events for ACS, UAP+NSTEMI, AMI patients was 3.38,3.0 and 3.9 respectively.Conclusions:1. ACS group's PAPP-A level was higher than NC group, this indicated that PAPP-A might be correlated with instable plaques and became a new marker.2. PAPP-A had no correlation with the complexity of coronary artery disease.3. The AUCROC indicated that PAPP-A's diagnostic value for AMI patients was very limited, but slightly better for UAP patients.4. PAPP-A (0.9mIU/L) was a favorable predictor of clinical end events within 6 months for ACS, UAP+NSTEMI and AMI patients.5. We didn't discover the correlation between PAPP-A and hs-CRP, further explores was needed to confirm its effect on inflammation mechanism in CHD.
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