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Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease

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ABSTRACT

Pregnancy-associated plasma protein-A (PAPP-A) level is an independent predictor of acute cardiovascular event occurrence. To test the hypothesis that increased PAPP-A levels would be associated with a higher burden of coronary thin-cap fibroatheroma (TCFA) thereby underlying the heightened risk for cardiovascular events in patients with coronary artery disease; 154 patients (462 vessels and 975 plaques) with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) referred for percutaneous coronary intervention were assessed using 3-vessel virtual histology (VH)-intravascular ultrasound (IVUS). Thin-cap fibroatheroma virtual histology was defined as focal, necrotic core (NC)-rich (≥10% of cross-sectional area) plaques in contact with the lumen, and plaque burden ≥40%. Pregnancy-associated plasma protein-A levels were determined by sandwich enzyme-linked immunosorbent assay, and patients were divided into 3 groups based on PAPP-A level tertiles. Although the highest PAPP-A level tertile was not associated with 3-vessel plaque number, it was associated with 3-vessel VH-TCFA number and necrotic core volume. Patients with ≥3 VH-TCFAs had a higher PAPP-A level than patients with 1 to 3 VH-TCFAs or without any VH-TCFA (13.3 ± 11.8 versus 7.8 ± 4.7 versus 7.4 ± 4.7 mIU/L, P < 0.001, respectively). Moreover, PAPP-A level was an independent predictor of higher total number of VH-TCFAs (OR 1.18; 95% CI 1.07–1.29, P = 0.001). This VH-IVUS study demonstrated, for the first time to our knowledge, that higher PAPP-A levels are associated with higher 3-vessel TCFA burden in patients with coronary artery disease. Pregnancy-associated plasma protein-A, therefore, might be a useful serum biomarker to predict increased coronary TCFA burden and plaque instability.

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Pregnancy-associated plasma protein-A level for each number of TCFAs. The number of TCFAs at MLA, culprit vessel or 3-vessel strongly correlated with PAPP-A level; the more TCFAs, the higher the PAPP-A level. MLA = minimum lumen area, NC = necrotic core, PAPP-A = pregnancy-associated plasma protein-A, TCFA = thin-cap fibroatheroma.
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Figure 2: Pregnancy-associated plasma protein-A level for each number of TCFAs. The number of TCFAs at MLA, culprit vessel or 3-vessel strongly correlated with PAPP-A level; the more TCFAs, the higher the PAPP-A level. MLA = minimum lumen area, NC = necrotic core, PAPP-A = pregnancy-associated plasma protein-A, TCFA = thin-cap fibroatheroma.

Mentions: Thirty-eight patients (24.7%) had a VH-TCFA at the MLA site. Pregnancy-associated plasma protein-A levels were higher in patients with than without a VH-TCFA at the MLA site ([15.3 ± 13.2] mIU/L versus [7.7 ± 4.6] mIU/L, P < 0.001, respectively). In addition, the number of VH-TCFAs in the culprit vessel or among all 3 vessels strongly correlated with PAPP-A levels; the more VH-TCFAs, the higher the PAPP-A levels (Figure 2).


Level of Pregnancy-associated Plasma Protein-A Correlates With Coronary Thin-cap Fibroatheroma Burden in Patients With Coronary Artery Disease
Pregnancy-associated plasma protein-A level for each number of TCFAs. The number of TCFAs at MLA, culprit vessel or 3-vessel strongly correlated with PAPP-A level; the more TCFAs, the higher the PAPP-A level. MLA = minimum lumen area, NC = necrotic core, PAPP-A = pregnancy-associated plasma protein-A, TCFA = thin-cap fibroatheroma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998284&req=5

Figure 2: Pregnancy-associated plasma protein-A level for each number of TCFAs. The number of TCFAs at MLA, culprit vessel or 3-vessel strongly correlated with PAPP-A level; the more TCFAs, the higher the PAPP-A level. MLA = minimum lumen area, NC = necrotic core, PAPP-A = pregnancy-associated plasma protein-A, TCFA = thin-cap fibroatheroma.
Mentions: Thirty-eight patients (24.7%) had a VH-TCFA at the MLA site. Pregnancy-associated plasma protein-A levels were higher in patients with than without a VH-TCFA at the MLA site ([15.3 ± 13.2] mIU/L versus [7.7 ± 4.6] mIU/L, P < 0.001, respectively). In addition, the number of VH-TCFAs in the culprit vessel or among all 3 vessels strongly correlated with PAPP-A levels; the more VH-TCFAs, the higher the PAPP-A levels (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Pregnancy-associated plasma protein-A (PAPP-A) level is an independent predictor of acute cardiovascular event occurrence. To test the hypothesis that increased PAPP-A levels would be associated with a higher burden of coronary thin-cap fibroatheroma (TCFA) thereby underlying the heightened risk for cardiovascular events in patients with coronary artery disease; 154 patients (462 vessels and 975 plaques) with stable angina or non-ST-segment elevation acute coronary syndrome (NSTE-ACS) referred for percutaneous coronary intervention were assessed using 3-vessel virtual histology (VH)-intravascular ultrasound (IVUS). Thin-cap fibroatheroma virtual histology was defined as focal, necrotic core (NC)-rich (&ge;10% of cross-sectional area) plaques in contact with the lumen, and plaque burden &ge;40%. Pregnancy-associated plasma protein-A levels were determined by sandwich enzyme-linked immunosorbent assay, and patients were divided into 3 groups based on PAPP-A level tertiles. Although the highest PAPP-A level tertile was not associated with 3-vessel plaque number, it was associated with 3-vessel VH-TCFA number and necrotic core volume. Patients with &ge;3 VH-TCFAs had a higher PAPP-A level than patients with 1 to 3 VH-TCFAs or without any VH-TCFA (13.3&#8202;&plusmn;&#8202;11.8 versus 7.8&#8202;&plusmn;&#8202;4.7 versus 7.4&#8202;&plusmn;&#8202;4.7&#8202;mIU/L, P&#8202;&lt;&#8202;0.001, respectively). Moreover, PAPP-A level was an independent predictor of higher total number of VH-TCFAs (OR 1.18; 95% CI 1.07&ndash;1.29, P&#8202;=&#8202;0.001). This VH-IVUS study demonstrated, for the first time to our knowledge, that higher PAPP-A levels are associated with higher 3-vessel TCFA burden in patients with coronary artery disease. Pregnancy-associated plasma protein-A, therefore, might be a useful serum biomarker to predict increased coronary TCFA burden and plaque instability.

No MeSH data available.


Related in: MedlinePlus