the role of insulin-like growth factor-1 and pregnancy-associated plasma protein-a in diagnosis of acute coronary syndrome and its related morbidities

Introduction: pregnancy-associated plasma protein-a (papp-a) is a metalloproteinase that plays a role in atherosclerotic plaque destabilization. in recent studies, insulin-like growth factor-1 (igf-1) has been introduced as a mediator of atherosclerosis. papp-a and igf-1 level may be important diagnostic indicators of acute coronary syndrome (acs). objective: the present study tried to assess the diagnostic role of igf-1 and papp-a biomarkers in acs spectrum. methods: the serum level of igf-1, papp-a and troponin i was determined in 121 consecutive patients with acs. relationships were assessed by t-test, anova and the non-parametric equivalent. accuracy of biomarkers was measured by the area under the roc curve (auc) and optimal cut-off points to diagnose stemi and nstemi using youden index. results: in patients with acute st segment elevation myocardial infarction (stemi), all of these three biomarkers were significantly higher than those in patients with unstable angina (p= 0.028 for igf-1, p<0.001 for papp-a and troponin-i). mean level of igf-1 in patients with renal failure was significantly higher than that in patients without renal failure (137.9±35.1 vs 105.1±46.9, p=0.003), but papp-a and serum troponin-i level had no significant difference in renal failure groups (p>0.05). roc curve analysis showed that after troponin-i, papp-a was a good discriminator between patients with stemi and patients with unstable angina (auc=0.79). optimum cut-off value for papp-a was found to be 89.2 ng/ml, with sensitivity and specificity of 66.7% and 83.8%, respectively. conclusion: papp-a can be a novel biomarker for both identification of patients with stemi and risk stratification in patients with acs.