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Clinical and research medicine: Acute coronary syndrome
e0440 Pregnancy-associated plasma protein-a polymorphisms and the risks of acute coronary syndrome
  1. Caixia Tian1,
  2. Weichao Qin1,
  3. Weidong Zheng2,
  4. Tangxin Liu
  1. 1Renmin Hospital of Yunyang Medical College
  2. 2Taihe Hospital of Yunyang Medical College


Background Pregnancy-associated plasma protein-A (PAPP-A) is known to be abundantly expressed in vulnerable plaques in arteriosclerotic disease. Studies have shown PAPP-A to be a sensitive biomarker of plaque instability and cardiovascular events in patients with acute coronary syndrome. This paper tried to determine the association of PAPP-A polymorphisms with acute coronary syndrome (ACS).

Methods A case-control study of 210 patients with ACS and 204 unrelated age and sex matched controls was performed. four single nucleotide polymorphisms (SNPs) of PAPP-A gene variants were detected by PCR-restriction fragment length polymorphism (PCR-RFLP). The serum level of PAPP-A was measured using a newly developed sandwich ELISA technique based on 2 monoclonal antibodies.

Results Mean PAPP-A values were significantly higher in patients with acute coronary syndrome than in those with stable angina pectoris (29.7 vs 15.8 mIU/l, p <0.01). In samples drawn <2 h after admission, the sensitivity of PAPP-A was superior (93%) to that of CK-MB (60%) and troponin T (61%). In the patients with high-risk unstable angina pectoris, PAPP-A was related to the risk of nonfatal myocardial infarction (p=0.02) but not death (p=0.08). This result was consistent on multivariate analysis of the combination of mortality or nonfatal myocardial infarction (OR 2.65, 95% CI 1.40 to 5.03). In patients with non-ST-elevation acute coronary syndrome and ST elevation myocardial infarctions, PAPP-A was related to the risk of death (p=0.01). This was also true after adjustment for other univariate predictors of death (OR 2.19, 95% CI 1.16 to 4.16). Multiple logistic regression analysis with risk factors such as age, male sex, smoking, hypertension, diabetes mellitus, and dyslipidemia revealed the PAPP-A IVS6+95 C allele (dbSNP: rs13290387) to be associated with an increased risk of ACS (OR, 2.44; 95% CI 1.21 to 3.98; p=0.018). The IVS6+95 (G/C) polymorphism in the PAPP-A gene has been reported 102 cases (48.6%) were GG and 80 cases (38.1%) were GC and 28 cases (13.3%) were CC for the ACS group; the respective figures were 116 (56.9%) and 70 (34.3%) and 18 (8.8%) in the controls. Patients carrying the C allele had a tendency to increased risk of ACS.

Conclusions In the early stages of non-ST-elevation acute coronary syndrome and ST elevation myocardial infarctions, PAPP-A seems to be a more sensitive marker of myocardial infarction than CK-MB and troponin T. PAPP-A seems to be valuable in predicting the outcomes of patients admitted with high-risk NSTE-ACS or STEMI. PAPP-A IVS6+95 C allele is an independent risk factor for ACS even after adjustment for traditional risk factors.

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