Elsevier

Clinica Chimica Acta

Volume 493, June 2019, Pages 8-13
Clinica Chimica Acta

The impact of preoperative fibrinogen-albumin ratio on mortality in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

https://doi.org/10.1016/j.cca.2019.02.018Get rights and content

Highlights

  • Inflammation and hemorheology play important roles in the origin and development of STEMI.

  • Combining two opposing indicators could improve comprehensive clinical evaluation.

  • FAR is a promising biomarker for predicting prognosis and improving risk stratification in STEMI.

Abstract

Background

We investigated the prognostic value of fibrinogen-albumin ratio (FAR) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) based on inflammation and hemorheology alterations and to determine whether FAR can supplement incremental predictive information to the Global Registry of Acute Coronary Events (GRACE) score.

Methods

We retrospectively analyzed 475 STEMI patients undergoing pPCI. Kaplan-Meier curve, Cox proportional hazards regression model, and Hosmer-Lemeshow test were used to evaluate the prognostic value of FAR in the patients.

Results

Patients were assigned to groups of high FAR (≥0.080) vs low FAR (<0.080) based on the optimal cutoff value of 0.080. In all, 59 patients (12.4%) died; the mortality rate was higher in high FAR patients than in low FAR patients (20.5% vs. 8.6%, p < .001). FAR positively correlated with C-reactive protein, GRACE score, and Gensini score (p < .001). On multivariate analysis, FAR was an independent prognostic factor in STEMI patients undergoing pPCI. Accordingly, adding FAR to the GRACE score improved the C-index, net reclassification index, and integrated discrimination improvement.

Conclusions

Preoperative FAR is an independent prognostic factor in STEMI patients undergoing pPCI and might improve risk stratification in STEMI.

Introduction

Coronary atherosclerotic heart disease is the leading cause of morbidity and mortality worldwide. Acute ST-segment elevation myocardial infarction (STEMI) is the most serious type of coronary heart disease (CHD). Despite tremendous advances in revascularization strategies, including percutaneous coronary intervention (PCI), coronary artery bypass graft, and coronary intensive care, the first-year mortality rate for STEMI patients remains approximately 10% [1]. Researchers have been trying to identify more effective predictors to improve prognosis of acute myocardial infarction (AMI)-related mortality. The Global Registry of Acute Coronary Events (GRACE) [2] score is currently one of the most widely used risk stratification tools and predictors of mortality in STEMI patients. However, the GRACE score still needs to be improved because it does not include some disease dimensions concerning STEMI outcomes such as inflammation, hemorheology, and coronary artery lesion. Separate biomarkers addressing such aspects of STEMI pathophysiology may provide additional information [3].

CHD is a chronic inflammatory state and the inflammatory reaction is involved throughout the pathological process of atherosclerosis, from fatty streak formation during coronary atherosclerosis development to plaque rupture during AMI [4,5]. Simultaneously, high plasma viscosity and thrombus tendency are considered primary risk factors for acute coronary syndrome and thrombotic events [6,7]. However, evaluating inflammatory status and hemorheological alteration is useful in inflammatory and thrombotic diseases but is complex and expensive, so the clinical application is limited.

Fibrinogen (FIB) and albumin (ALB) are widely used and important factors in response to systemic inflammatory and hemorheological alterations. Previous studies have shown that increased concentration of FIB, a positive acute-phase inflammatory protein that increases thrombosis risk, is an independent predictor of CHD and MI [8,9]. Increased FIB concentration is an independent factor in myocardial injury prognosis [8]. In contrast, studies have shown that decreased concentration of ALB, a negative inflammatory protein and major factor affecting plasma viscosity, is a risk factor for incident AMI in patients with CHD and is associated with increased cardiovascular morbidity and long-term mortality [10,11]. Furthermore, hypoalbuminemia can predict the no-flow phenomenon in STEMI patients after PCI [12].

Fibrinogen-albumin ratio (FAR), comprising these two indicators, is a valuable serological marker [13] that may reflect information on hemorheology and inflammation as well as some possible additional disease conditions in STEMI patients. Increased FAR concentration have been reported in patients with cardiovascular events [14,15] and are significantly associated with the severity of coronary stenosis in STEMI patients [15], suggesting that FAR may play an important role in vascular thrombotic diseases. Therefore, FAR may aid in STEMI prognosis, which has not been studied so far. We aimed to investigate the prognostic value of FAR for all-cause mortality in STEMI patients undergoing primary PCI (pPCI) and to determine whether FAR knowledge adds predictive information to the GRACE score.

Section snippets

Study population

The present investigation was a single-center, observational, retrospective cohort study among consecutive STEMI patients who underwent pPCI at Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China, from May 2016 to September 2017. The diagnosis of STEMI was based on the criteria determined by the American College of Cardiology [16] and the European Society of Cardiology [17], which was defined as >30 min of continuous typical chest pain and ST-segment elevation by

Baseline patient characteristics

In total, 475 consecutive STEMI patients undergoing pPCI were included in the study. The average age was 64.07 ± 13.47 y, and 363 (76.4%) were males. The median interval between the appearance of symptoms before pPCI and blood sampling was 5.2 (2.3–10.5) h. Of these patients, 23 (4.8%) died while they were hospitalized and 36 (7.6%) died during the follow-up period (median follow-up duration, 14.4 [9.3–17.6] months). The median preoperative FAR value among patients was 0.067 (0.054–0.087). The

Discussion

Our study showed that FAR may be associated with cardiovascular risk factors and underlying cardiovascular disease burden; accordingly, the patients with high FAR had older age and higher total cholesterol, creatinine, cTnT, and NT-proBNP concentration in addition to worse cardiac function (Killip class and LVEF) than patients with low FAR. FAR had a significantly positive correlation with the Gensini score, which is an effective and relatively simple means of quantifying angiographic

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    These authors contributed equally to this work.

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