Pregnancy-associated plasma protein A values in patients with stable cardiovascular disease: Use of a new monoclonal antibody-based assay

Olaf Schulz, Markus Reinicke, Jochen Krämer, Gunnar Berghöfer, Ricarda Bensch, Ingolf Schimke, Allan Jaffe

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: PAPP-A is promising in improving risk stratification and invasive treatment decisions in stable cardiovascular patients. We evaluated the prognostic value of pregnancy-associated plasma protein A (PAPP-A) measured by a novel assay in stable cardiovascular patients. Methods: We investigated 228 stable cardiovascular outpatients. Blood was drawn for PAPP-A measurement after echocardiography and ergometry prior to heart catheterization. Angiographically we determined severity as well as qualitative characteristics suspect for vulnerability of coronary lesions. After 1108 ± 297. days, follow-up information was obtained by questionnaire mailings and interviews by phone. Results: 104 patients had coronary stenosis ≥ 70%, 75 had B-type lesions ≥ 50%, 46 showed complex lesions, and 68 were suspected to have vulnerable lesions. Median PAPP-A was 1.76 (interquartile range 1.21, 2.63) μIU/ml in the entire cohort. PAPP-A concentrations did not differ in dependence on coronary artery findings. A cutpoint of 2.7. μIU/ml was derived from receiver-operator characteristics for outcome measures. For this cutoff, Cox proportional hazard models with 19 further clinical variables showed that PAPP-A was predictive for all-cause death (HR 4.73, 95% CI 1.46-15.31, p = 0.01), all-cause death or nonfatal infarction (HR 4.01, 95% CI 1.58-10.13, p = 0.003) and all-cause death, nonfatal myocardial infarction or hospitalization (HR 1.96, 95% CI 1.03-3.70, p = 0.04). The predictive value of PAPP-A did not change substantially after correction for values of cardiac troponin, using a highly sensitive cardiac troponin I research assay. Conclusions: PAPP-A, measured by a new, monoclonal antibody-based assay is a promising prognostic marker in patients with stable cardiovascular disease and an indication for heart catheterization.

Original languageEnglish (US)
Pages (from-to)880-886
Number of pages7
JournalClinica Chimica Acta
Issue number11-12
StatePublished - May 12 2011


  • PAPP-A
  • Prognosis
  • Stable cardiovascular disease

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Biochemistry, medical


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