Pregnancy-associated plasma protein-A (PAPP-A) is a potential marker of the vulnerable plaque. Given its known pathophysiological properties, it can be theoretically used not only in the early diagnosis of acute coronary syndrome (ACS) and its prognosis but, also, in the risk stratification of patients with no signs of coronary disease.
A critical factor in deciding whether PAPP-A determination becomes part of routine clinical practice or fall into oblivion as did a host of other originally promising markers will be whether various aspects of this quick and accurate technique of determination become widely available. However, even if not eventually employed in the routine diagnosis of ACS, future study of the pathophysiology of PAPP-A and insulin-like growth factor is likely to furnish a number of important data on the development both of atherosclerotic disease and general processes of cellular aging.