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Report by Richard Body, Clinical Research Fellow Search checked by Craig Ferguson, Clinical Research Fellow Manchester Royal Infirmary, Manchester, UK
Three-part question
In [patients with chest pain of suspected cardiac origin] does [measurement of serum PAPP-A [pregnancy-associated plasma protein A] on admission] allow [exclusion of acute coronary syndromes]?
Clinical scenario
A 45-year-old abusive, intoxicated recurrent attender complains of central chest pain of 2 h duration. His initial electrocardiogram is normal. Your gut feeling is that he does not have an acute coronary syndrome. You are reluctant to admit him for troponin estimation at 12 h, but wonder if you ought to risk discharge without further investigation. Having heard about PAPP-A, a promising cardiac marker, you wonder if the evidence is sufficient to allow it to …
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