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Our study shows that the prognosis is unsatisfactory in warfarin-treated patients irrespective of the drug combination used. Aspirin plus warfarin combination seems to be inadequate to prevent stent thrombosis.

Background-Risk stratification in troponin (cTn)-negative acute coronary syndrome (ACS) remains a clinical challenge.We investigated the predictive value of circulating pregnancy-associated plasma protein A (PAPP-A), a novel marker of atherosclerotic plaque activity, in these patients. Methods and Results-Two hundred consecutive hospitalized ACS patients were included, of whom 136 (69 men and 67 women; meanϮSD age, 66Ϯ16 years) remained cTnI-negative for up to 24 hours. PAPP-A was measured at admission, 6 to 12 hours, and 24 hours. During 6-month follow-up, 26 (19.1%) of the cTnI-negative patients reached a primary end point (cardiovascular death, myocardial infarction, or revascularization). At a cutoff level of 2.9 mIU/L, elevated PAPP-A was an independent predictor of adverse outcome (adjusted risk ratio [RR], 4.6; 95% confidence interval, 1.8 to 11.8; Pϭ0.002). Another independent predictor was admission CRP Ͼ2.0 mg/L (RR, 2.6; Pϭ0.03). Conclusions-Measurement of plasma PAPP-A, a zinc-binding matrix metalloproteinase, is a strong independent predictor of ischemic cardiac events and need of revascularization in patients who present with suspected myocardial infarction but remain troponin negative. (Circulation. 2003;108:1924-1926.)

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Our study shows that PCI is a safe procedure during UAC with no excess bleeding complications.