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ȣ - 500715 147 |
| Serum pregnancy-associated plasma protein-A levels in patients undergoing percutaneous coronary intervention |
| 경북대학교 의과대학 순환기내과¹ , 대구 파티마병원² |
| 이동엽¹, 양동헌¹ ,박용휘¹ ,이현상¹ ,장귀련¹ ,이봉렬² ,박헌식¹ ,조용근¹ ,채성철¹ ,전재은¹ ,박의현¹ |
Background : Pregnancy-associated plasma protein-A (PAPP-A) is known to be involved in formation and progression of coronary artery disease. The aims of this study were to evaluate the changes of serum PAPP-A levels in patients undergoing percutaneous coronary intervention (PCI), to elucidate clinical and angiographic factors influencing to the levels of PAPP-A and to evaluate short-term prognostic value of PAPP-A. Method : One hundred patients undergoing PCI were included from 1st Jan 2005 to 7th Aug 2005 (30 with stable angina, 70 with acute coronary syndrome). Serum PAPP-A concentrations were measured with ELISA method (DSL-10-27200 ACTIVE, Ultra-sensitive, USA) in blood samples withdrawn before coronary angiography and after PCI. Results : Serum levels of PAPP-A before PCI (pre-PCI PAPP-A) was 0.77 ± 0.45 mIU/L. Pre-PCI PAPP-A were lower in diabetics (0.62 ± 0.29 mIU/L vs 0.82 ± 0.48 mIU/L, p=0.038) and had negative correlations with serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). However, pre-PCI PAPP-A did not correlate with high sensitive C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and angiographic Gensini score. The serum levels of PAPP-A significantly increased immediately after PCI to 18.73 ± 15.42 mIU/L (28.2±25.0 times). The increases of serum PAPP-A after PCI were higher in patients with single vessel disease or simple plaque, or patients undergoing single PCI. Post-PCI PAPP-A levels negatively correlated with weight, body mass index (BMI), TC, TG and LDL-C. Ten cardiac events (acute coronary syndrome or revascularization) were occurred. Patients with cardiac events had higher pre-PCI PAPP-A (1.00 ± 0.49 mIU/L vs 0.75 ± 0.44 mIU/L) and lower post-PCI PAPP-A (10.45 ± 8.51 mIU/L vs 19.65 ± 15.77 mIU/L). Post-PCI PAPP-A to pre-PCI PAPP-A ratio was lower in event group (12.6±9.7 vs 29.9±25.6 times, p<0.0001). Pre-PCI PAPP-A had a prognostic value to predict cardiac events in Cox regression analysis (p=0.022, hazard ratio=3.666, 95% CI: 1.202-11.182). Conclusion : Serum levels of PAPP-A were markedly increased after PCI immediately and had a prognostic value predicting future cardiac events.
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