PAPPA and coronary artery disorder: Later, some studies demonstrated that PAPP-A induces a pro-thrombotic phenotype in endothelial cells by inducing expression of functionally active tissue factor [16] and that transcoronary PAPP-A levels are significantly higher in ACS patients as compared to patients with stable coronary artery disease, indicating that PAPP-A plays a role in the pathophysiology of ACS [17].