BACKGROUND: The rupture of coronary atherosclerotic plaque and subsequent thrombus formation are major events underlying acute coronary syndromes (ACS). Pregnancy associated plasma protein A (PAPP-A), a biomarker of plaque rupture, has been studied in patients with ACS. This review aimed to provide an overview of clinical utility of PAPP-A in ACS patients and analytical issues adhering to immunological PAPP-A measurement. METHODS: The literature relating to PAPP-A in ACS, the molecular structure and immunodetection of PAPP-A was reviewed. PubMed was used to search the relevant articles published from 1974 to 2006. RESULTS: Higher PAPP-A concentrations have been found in patients with ACS than in patients with stable angina and subjects without coronary artery disease. Elevated PAPP-A concentrations have also been shown to associate with adverse cardiac events in ACS patients. The prognostic value of PAPP-A appears to be independent of cardiac troponins. Noteworthy, the PAPP-A form that accounts for increase in ACS is uncomplexed with the proform of eosinophil major basic protein (proMBP). However, PAPP-A assays applied in clinical studies published thus far detect total PAPP-A. Consequently, the clinical value may be non-optimal when total PAPP-A is measured in ACS patients. In addition, the clinical value can also be affected by the analytical factors that exert an effect on the performance of PAPP-A assays. CONCLUSIONS: PAPP-A appears to be a very promising biomarker useful in the clinical management of ACS patients. However, more prospective and interventional studies with carefully established immunoassays are required to validate its clinical utility.
BACKGROUND: The rupture of coronary atherosclerotic plaque and subsequent thrombus formation are major events underlying acute coronary syndromes (ACS). Pregnancy associated plasma protein A (PAPP-A), a biomarker of plaque rupture, has been studied in patients with ACS. This review aimed to provide an overview of clinical utility of PAPP-A in ACS patients and analytical issues adhering to immunological PAPP-A measurement. METHODS: The literature relating to PAPP-A in ACS, the molecular structure and immunodetection of PAPP-A was reviewed. PubMed was used to search the relevant articles published from 1974 to 2006. RESULTS: Higher PAPP-A concentrations have been found in patients with ACS than in patients with stable angina and subjects without coronary artery disease. Elevated PAPP-A concentrations have also been shown to associate with adverse cardiac events in ACS patients. The prognostic value of PAPP-A appears to be independent of cardiac troponins. Noteworthy, the PAPP-A form that accounts for increase in ACS is uncomplexed with the proform of eosinophil major basic protein (proMBP). However, PAPP-A assays applied in clinical studies published thus far detect total PAPP-A. Consequently, the clinical value may be non-optimal when total PAPP-A is measured in ACS patients. In addition, the clinical value can also be affected by the analytical factors that exert an effect on the performance of PAPP-A assays. CONCLUSIONS:PAPP-A appears to be a very promising biomarker useful in the clinical management of ACS patients. However, more prospective and interventional studies with carefully established immunoassays are required to validate its clinical utility.
Authors: Peter A Kavsak; Andrew Worster; John J You; Mark Oremus; Adell Elsharif; Stephen A Hill; P J Devereaux; Andrew R MacRae; Allan S Jaffe Journal: Clin Biochem Date: 2009-12-21 Impact factor: 3.281
Authors: Peter A Kavsak; Xuesong Wang; Matthew Henderson; Dennis T Ko; Andrew R MacRae; Allan S Jaffe Journal: Clin Biochem Date: 2009-03-25 Impact factor: 3.281
Authors: Stephan von Haehling; Wolfram Doehner; Ewa A Jankowska; Piotr Ponikowski; Konstantinos Stellos; Valentina O Puntmann; Eike Nagel; Stefan D Anker; Meinrad Gawaz; Boris Bigalke Journal: CMAJ Date: 2013-03-18 Impact factor: 8.262
Authors: Priya Gururajan; Prema Gurumurthy; Pradeep Nayar; G Srinivasa Nageswara Rao; R Sai Babu; A Sarasabharati; K M Cherian Journal: Indian Heart J Date: 2012-04-28
Authors: M B I Lobbes; M E Kooi; E Lutgens; A W Ruiters; V Lima Passos; S H J G Braat; M Rousch; H Ten Cate; J M A van Engelshoven; M J A P Daemen; S Heeneman Journal: Int J Vasc Med Date: 2010-05-30