Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus

• Published in: Cardiovascular diabetology Vol. 16; no. 1; pp. 45 - 11
• Main Authors: Li, Wei-Ping, Neradilek, Moni B, Gu, Fu-Sheng, Isquith, Daniel A, Sun, Zhi-Jun, Wu, Xing, Li, Hong-Wei, Zhao, Xue-Qiao
• Format: Journal Article
• Language: English
• Published: England BioMed Central 05.04.2017; BMC
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers - blood; Cardiovascular disease; Cardiovascular outcomes; Case-Control Studies; Chi-Square Distribution; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - mortality; Enzymes; Epidermal growth factor receptors; Female; Glucose; Heart attacks; Humans; Inflammation; Kaplan-Meier Estimate; Laboratories; Logistic Models; Male; Measurement methods; Middle Aged; Multivariate Analysis; Non-ST Elevated Myocardial Infarction - blood; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - etiology; Non-ST Elevated Myocardial Infarction - mortality; Original Investigation; Patient Admission; Plasma; Predictive Value of Tests; Pregnancy; Pregnancy-associated plasma protein-A; Pregnancy-Associated Plasma Protein-A - analysis; Prognosis; Proportional Hazards Models; Prospective Studies; Proteins; Recurrence; Regression analysis; Risk Assessment; Risk Factors; ROC Curve; ST Elevation Myocardial Infarction - blood; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - etiology; ST Elevation Myocardial Infarction - mortality; Stroke; Time Factors; Type-2 diabetes mellitus; Ultrasonic imaging; Up-Regulation; Cardiovascular outcomes; Type-2 diabetes mellitus; Acute coronary syndrome; Pregnancy-associated plasma protein-A
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-017-0526-6

The risk prediction of pregnancy-associated plasma protein-A (PAPP-A) for future cardiovascular (CV) events post acute coronary syndrome (ACS) in patients with type-2 diabetes mellitus (T2DM) was investigated in comparison to other risk factors. PAPP-A was measured at hospital admission in 320 consecutive ACS patients (136 with T2DM and 184 without). All patients were followed for 2 years for occurrence of CV death, non-fatal MI or stroke. Effect of PAPP-A on the CV event risk was estimated using Cox regression models. Receiver operating characteristics (ROC) curves were generated to demonstrate the sensitivity and specificity of PAPP-A in predicting CV events. ACS patients with T2DM had higher PAPP-A (19.29 ± 16.36 vs. 13.29 ± 13.90 ng/ml, p < 0.001) and higher rate of CV events 2 years post ACS (27.2 vs. 13.6%, p = 0.002) than those without. Higher levels of PAPP-A were significantly associated with increased risk of CV events during 2-year follow-up [HR = 2.97 for 1 SD increase in log (PAPP-A), 95% CI 2.11-4.18, p < 0.001] in T2DM and (HR = 3.16, 95% CI 2.27-4.39, p < 0.001) in non-T2DM. Among patients with T2DM, PAPP-A showed a larger area under the curve (AUC 0.79) that was significantly more predictive than hsCRP (AUC 0.64), eGFR (AUC 0.66) and LVEF < 50% (AUC 0.52); predictive ability did not improve significantly by including those factors into the model. Patients with T2DM had higher levels of PAPP-A and increased risk of CV events. Elevated PAPP-A compared to other risk factors was a stronger predictor for future CV events 2 years post ACS in patients with T2DM. Trial registration ISRCTN10805074. Registered on 20 January 2017, retrospectively registered.