Prognostic value of circulating pregnancy-associated plasma protein-A (PAPP-A) and proform of eosinophil major basic protein (pro-MBP) levels in patients with chronic stable angina pectoris.

BACKGROUND: Pregnancy-associated plasma protein-A (PAPP-A) concentrations predict outcome in patients with acute coronary syndromes. PAPP-A levels and PAPP-A/pro-MBP ratio are increased in chronic stable angina (CSA) patients with complex coronary artery stenoses. Little is known however, about the long-term prognostic value of PAPP-A and pro-MBP in "real-life" CSA patients. We sought to assess whether PAPP-A, the proform of eosinophil major basic protein (pro-MBP) and PAPP-A/pro-MBP levels predict long-term all-cause mortality in patients with CSA.
METHODS: We recruited 663 consecutive patients (169 women [25.5%]; mean age 62.9+/-9.7 years) undergoing routine diagnostic coronary angiography. Samples for PAPP-A and pro-MBP were taken at study entry. Patients were followed for a median of 8.8 years (interquartile range 3 - 10.6 years).
RESULTS: 106 patients (16%) died during follow-up. On a Cox proportional hazards model, increased PAPP-A concentration (>4.8 mIU/L) was an independent predictor of the occurrence of all-cause mortality (HR 1.953, 95% CI 1.135-3.36, p=.016). Neither pro-MBP nor PAPP-A/pro-MBP ratio were markers of all-cause mortality (p=.45 and .54, respectively).
CONCLUSIONS: High PAPP-A levels (>4.8 mIU/L) showed an association with all-cause mortality during long-term follow-up in patients with CSA.