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Open Access 01-12-2017 | Original investigation

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

Authors: Wei-Ping Li, Moni B. Neradilek, Fu-Sheng Gu, Daniel A. Isquith, Zhi-Jun Sun, Xing Wu, Hong-Wei Li, Xue-Qiao Zhao

Published in: Cardiovascular Diabetology | Issue 1/2017

Abstract

Background

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.

Methods

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.

Results

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 log₁₀(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.

Conclusions

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.

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Title: Pregnancy-associated plasma protein-A is a stronger predictor for adverse cardiovascular outcomes after acute coronary syndrome in type-2 diabetes mellitus
Authors: Wei-Ping Li
Moni B. Neradilek
Fu-Sheng Gu
Daniel A. Isquith
Zhi-Jun Sun
Xing Wu
Hong-Wei Li
Xue-Qiao Zhao
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Cardiovascular Diabetology / Issue 1/2017
Electronic ISSN: 1475-2840
DOI: https://doi.org/10.1186/s12933-017-0526-6

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

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

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Conclusions

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