PAPPA and acute coronary syndrome: In another cohort study, including 534 patients with stable CAD and 393 patients with acute coronary syndrome, with a median follow-up time of 5.0 years, the authors found no association to cardiovascular mortality in the subgroup stable CAD, but higher PAPP-A was associated with increased cardiovascular mortality in the overall cohort as well as in the acute coronary syndrome (ACS) subgroup [19].