PAPP-A as a marker of increased long-term risk in patients with chest pain

Peter A. Kavsak, Xuesong Wang, Matthew Henderson, Dennis T. Ko, Andrew R. MacRae, Allan S. Jaffe

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Objectives: Long-term risk stratification in patients presenting with acute coronary syndromes (ACS) is possible by measuring cardiac troponin (cTn). The present study examined whether PAPP-A measured in an emergency department (ED) chest pain population in association with conventional and novel high sensitivity cTn (hs-cTnI) assays can predict long-term mortality. Methods: In 320 patients with cTn measurements the earliest heparinized plasma PAPP-A concentration after presentation was used for risk stratification for death by Kaplan-Meier and Cox analyses. Subgroup analyses using the earliest PAPP-A concentrations were also performed in a cohort of subjects with presentation cTnI ≤ 99th percentile but with significantly changing cardiac troponin concentrations as measured by the AccuTnI assay and the hs-cTnI assay (n = 45 and 120 subjects, respectively). Results: Subjects with PAPP-A concentrations in the highest tertile were at higher risk for death (HR > 2.00; p ≤ 0.05 at 2 years) even after adjusting for cTnI at presentation. In the cohort with cTnI ≤ 99th percentile but with changing hs-cTnI concentrations, subjects in the top PAPP-A tertile had a higher probability for death (p = 0.02). Conclusion: Early measurement of PAPP-A may identify chest pain patients at higher risk for long-term death. Additional prospective ACS studies are required to fully elucidate PAPP-A's role.

Original languageEnglish (US)
Pages (from-to)1012-1018
Number of pages7
JournalClinical Biochemistry
Issue number10-11
StatePublished - Jul 2009


  • Cardiac troponin
  • Death
  • Emergency department
  • High sensitivity
  • Pregnancy associated plasma protein A

ASJC Scopus subject areas

  • Clinical Biochemistry


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