Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome.

AIMS AND OBJECTIVES: Pregnancy associated plasma protein-A (PAPP-A), a metalloproteinase plays a pivotal role in the pathogenesis of atherosclerosis. Recent studies have reported that elevated levels of PAPP-A, signal the onset of acute coronary syndrome (ACS). We, therefore, proposed to study the analytical competence of PAPP-A in patients admitted to the emergency department with chest pain and finally diagnosed as ACS. METHODS AND RESULTS: Pregnancy associated plasma protein-A was measured using enzyme-linked immunosorbent assay (ELISA) in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as Non-cardiac chest pain (NCCP). Elevated levels of PAPP-A were observed in patients diagnosed as ACS on comparison with the controls. Receiver operator characteristic (ROC) curve analysis showed PAPP-A to be a good discriminator between ischaemic and non-ischaemic patients. The area under the curve was found to be 0.904, 95% CI (0.874-0.929) with 90% sensitivity and 85% specificity (P< 0.0001). The cut-off value from the ROC curve was 0.55 µg/mL above which PAPP-A was considered to be positive. CONCLUSION: Pregnancy associated plasma protein-A seems to be a promising biomarker for identification and risk stratification for patients with ACS.

Lipid profile and non-enzymic antioxidant status in patients with acute coronary syndrome in South India.

AIMS AND OBJECTIVES: Elevated lipid profile and reduced antioxidants accelerate the formation of atherosclerosis. Multiple lines of evidences have suggested that increased lipids and low antioxidants are the major risk factors for the incidence of acute coronary syndrome. Oxidative stress evaluation is now considered as an index for the assessment of development of coronary artery disease. Therefore, we studied association of the levels of non-enzymic antioxidants and lipid profile in controls and patients with acute coronary syndrome (ACS). METHODS AND RESULTS: The present study was carried out on 485 patients admitted to the emergency care unit, of whom 89 patients were diagnosed as non-cardiac chest pain (NCCP). Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides were analysed along with non-enzymic antioxidants such as vitamin C, vitamin E, reduced glutathione, MDA and protein thiol in controls and patients with ACS. The levels of total cholesterol and LDL-cholesterol were significantly raised in patients when compared to controls in contrast to lowering of HDL-cholesterol levels in patients than controls. Vitamin C, vitamin E, reduced glutathione, MDA and protein thiol levels were significantly lowered in patients than controls (p<0.05). CONCLUSION: Oxidative stress and lipid profile should be included as important markers in the early detection of acute coronary syndrome.

Increased serum concentrations of Soluble CD40 Ligand as a prognostic marker in patients with Acute Coronary Syndrome.

CD40-CD40L interaction plays a significant role in the pathogenesis of atherosclerosis and coronary artery disease. The clinical predictive value of Soluble CD40 Ligand (sCD40L) was evaluated in patients with Acute Coronary Syndrome (ACS) and Non-Cardiac Chest Pain (NCCP). The levels of serum soluble CD 40 ligand were measured by ELISA in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as NCCP. The levels of sCD40L were significantly increased in patients with ACS when compared to controls and NCCP. Receiver Operator Characteristic (ROC) Curve analysis showed sCD40L to be a good discriminator between patients with ischemic heart disease and patients without ischemic heart disease. The area under the curve was found to be 0.940 with 95% CI (0.915 to 0.960) (P<0.0001). The cut off value from the ROC curve was 2.99 ng/ml, above which sCD40L was considered to be positive. Combined assessment of sCD40L, Troponin I and CK-MB enhanced the risk prediction and early classification of patients. sCD40L seems to be a promising biomarker for identification and risk stratification for patients with acute coronary syndrome.

Serum myeloperoxidase: a novel biomarker for evaluation of patients with acute coronary syndrome.

OBJECTIVES: Myeloperoxidase, an abundant leucocyte enzyme, is elevated in culprit lesions that have ruptured in patients with sudden cardiac injury. Multiple lines of evidence suggest an association between myeloperoxidase and inflammation and acute coronary syndrome. Myeloperoxidase has been proposed as a potent risk marker and diagnostic tool in acute coronary syndrome (ACS). Recent studies have reported the potential use of myeloperoxidase in acute coronary syndrome, but limited reports are available on its utility in different groups of ACS in the emergency department. Therefore the circulating levels of serum myeloperoxidase in patients with acute coronary syndrome and control subjects were studied. DESIGN AND SETTING: The levels of serum myeloperoxidase were measured by ELISA in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as non-cardiac chest pain (NCCP). The levels of myeloperoxidase were significantly increased in patients with ACS when compared with controls and NCCP. From the receiver operator characteristic (ROC) curve analysis, the optimum value above which myeloperoxidase can be considered positive was found to be 48.02 U/ml. The area under the curve was found to be 0.956 with 95% CI (0.934 to 0.973) (p<0.0001). A combination analysis of ROC curves of troponin, creatine kinase MB (CK-MB) and myeloperoxidase showed myeloperoxidase to be highly significant. Multivariate analysis revealed myeloperoxidase to be an independent diagnostic marker for early diagnosis of ACS. CONCLUSION: Myeloperoxidase, in contrast to troponin and CK-MB, identified patients at risk of ischaemic events, even in the absence of myocardial necrosis, thus highlighting its potent usefulness for risk stratification among patients presenting with chest pain.