Abstract 9923: Circulating Pregnancy-Associated Plasma Protein Levels Reflect Plaque Instability and Predict the No-Reflow Phenomenon After Percutaneous Coronary Intervention

Abstract

Background and Aims Because coronary no-reflow phenomenon during percutaneous coronary intervention (PCI) is associated with a poor prognosis, it is clinically important to stratify high risk coronary no-reflow patients. Previous study reported that plasma pregnancy-associated plasma protein (PAPP-A) level was a marker of adverse outcome such as cardiac death and myocardial infarction in both acute coronary syndrome (ACS) and non-ACS patients. In the present study, we examined whether serum PAPP-A level could predict incidence of coronary no-reflow during PCI. Results Consecutive 85 patients (ACS, n=37; non-ACS, n=48; mean age 69 ± 11 years old) who were underwent PCI with integrated backscatter intravascular ultrasound (IB-IVUS) were prospectively enrolled. No-reflow, including transient filter no-reflow by using distal protection devices, was observed in 18 (21%) patients. Plasma PAPP-A levels were significantly higher in no-reflow patients compared with normal-reflow patients (8.25 ± 2.28 vs. 6.27 ± 1.54 ng/ml, P<0.001). To predict coronary no-reflow, a receiver operating characteristic (ROC) analysis determined a cut-off plasma PAPP-A value as 7.68 ng/ml (sensitivity of 62%, specificity of 82%, area under curve 0.76). The multivariate logistic regression analysis showed that plasma PAPP-A was an independent predictor of the no-reflow phenomenon (odds ratio 2.27; 95% confidence interval, 1.123-4.602; P = 0.023). Since plasma PAPP-A levels were not correlated (r=0.009, p=0.94) with culprit plaque percentage of lipid volume analyzed by IB-IVUS, they might be associated with not lipid plaque volume but plaque instability. Conclusion Plasma PAPP-A levels is a useful biomarker to stratify high risk coronary no-reflow patients during PCI. Plasma PAPP-A cut-off values determined by present study could help our approach for predicting high risk coronary no-reflow patients.