Pregnancy associated plasma protein-A as a prognostic biomarker of all-cause mortality and cardiovascular events in patients presenting with chest pain: a systematic review

Biomarkers. 2018 Feb;23(1):1-9. doi: 10.1080/1354750X.2017.1397194. Epub 2017 Nov 16.


Aim: Novel biomarkers have been proposed for identification of patients at greater risk of future adverse events among those presenting with chest pain. In this review, we aim to elucidate the ability of pregnancy associated plasma protein-A (PAPP-A) to predict mortality and other cardiovascular events in this patient population.

Methods: A literature search of the electronic databases Medline, Scopus, Cochrane Library and was performed in order to identify studies investigating the utility of PAPP-A to predict mortality and adverse cardiovascular events in patients with chest pain.

Results: Eight studies met our inclusion criteria. Five of these studies pertained to patients with confirmed ischemic chest pain, while the rest included patients presenting with chest pain possibly due to acute coronary syndrome, irrespectively of the underlying cause. Although the results for long-term events were inconclusive in both groups of patients, higher PAPP-A concentrations were found to be a significant predictor of short-term adverse events in patients with confirmed ischemic chest pain.

Conclusions: PAPP-A appears to be a potentially useful biomarker for short-term risk stratification of patients presenting with chest pain of ischemic origin. However, there is an eminent need for more standardized clinical studies investigating the prognostic value of this biomarker.

Keywords: Pregnancy associated plasma protein-A; cardiovascular; chest pain; prognosis; systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / mortality
  • Biomarkers / blood*
  • Cause of Death
  • Chest Pain / blood*
  • Chest Pain / complications
  • Female
  • Humans
  • Pregnancy-Associated Plasma Protein-A / analysis*
  • Prognosis
  • Risk Factors
  • Survival Rate


  • Biomarkers
  • Pregnancy-Associated Plasma Protein-A