Original Contribution
The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI☆

https://doi.org/10.1016/j.ajem.2016.03.003Get rights and content

Abstract

Objective

Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease (CAD) and that serum albumin levels are of a higher specificity and sensitivity in ST-elevation myocardial infarction (STEMI). In this study, we sought to evaluate the association between fibrinogen to albumin ratio (FAR) and the extent and severity of CAD evaluated by TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) Score (SS) in patients with STEMI.

Methods

A total of 278 patients with STEMI were included in the study. FAR was calculated using specified variables. The extent and severity of CAD were evaluated using the SS. The patients were divided into low- (SS < 22) and high- (SS ≥ 22) risk groups. A Spearman rank correlation coefficient analysis was used for the relationship between FAR and SS. The cutoff points for sensitivity and specificity of FAR in predicting SS were estimated by performing a receiver operator characteristic curve analysis.

Results

There were significant differences in the mean age (P = .016), admission serum albumin (P = .041), serum fibrinogen (P < .001), FAR (P < .001), and SS risk groups. Positive correlation was detected between FAR and SS (r = 0.458, P < .001). A cutoff level of > 87 FAR predicted SS (sensitivity, 70%; specificity, 70%), and an area under the curve of 0.758 serum fibrinogen and albumin level was an independent predictor for SS in patients with STEMI (b = 0.039; 95% confidence interval, 0.016-0.062; P = .001 and b = − 6.906; 95% confidence interval, − 12.284 to − 1.527; P = .013, respectively).

Conclusion

In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with STEMI.

Introduction

Coronary artery disease (CAD) and acute myocardial infarction (MI) are major causes of morbidity and death worldwide. Atherosclerosis is the major cause of cardiovascular disease [1], [2]. Coronary atherosclerosis is the main cause of ST-elevation acute myocardial infarction (STEMI) which can affect vessel wall in different degrees. Therefore, clinicians focus on studying risk stratification in patients with acute coronary syndrome (ACS) for the prediction of CAD severity and complexity. In this context, a large number of scoring systems and laboratory parameters have been used recently in clinical practice. The SYNTAX score (SS) is one of the scoring systems used to determine the extent and severity of CAD [3], [4], [5], [6].

Hypoalbuminemia has been found to be a risk factor for the development of a new MI in patients with CAD [7] and heart failure [8]. In addition, serum albumin (SA) is an important inhibitor of platelet activation and aggregation and is an important mediator of platelet-induced coronary artery constriction [9], [10]. In addition, hypoalbuminemia may increase blood viscosity and disrupt endothelial function because of increased concentrations of free lysophosphatidylcholine [11]. Several studies have shown a relationship between low SA levels and increased cardiovascular morbidity and mortality [12], [13]. The SA might also have an important role in the acute phase of CAD, such as acute STEMI.

Several studies show that elevated fibrinogen is an established risk factor in CAD [14], [15], [16].

Although many studies have investigated the relationship between hypoalbuminemia, high fibrinogen levels, and CAD [9], [10], [14], [15], to our knowledge, none have addressed the association between fibrinogen to albumin ratio (FAR) and the severity of CAD using SS in patients with STEMI.

Thus, the aim of the current study is to investigate whether a high FAR is associated with the extent and severity of CAD in patients with STEMI who underwent primary percutaneous coronary intervention (p-PCI) with SS.

Section snippets

Study population

This study was conducted prospectively. A total of 78 patients who presented with STEMIs and underwent p-PCI within 12 hours of symptom onset were included in the study. STEMI was defined based on the criteria created by the American College of Cardiology and the European Society of Cardiology and included the following: an increase in troponin I > 1 ng/mL; a new ST elevation as measured from the J-point in 2 or more contiguous leads with leads V1, V2, and V3 measuring at least 0.2 mV or at least 0.1

Results

A total of 78 patients (56 male [73%]; mean age, 61.5 ± 15.82 years) were enrolled in the study. Patients were divided into 2 groups according to SS (SS < 22 as low group [n = 37] and ≥ 22 as high group [n = 41]). The mean age of the SS-high group was higher than that of the SS-low group (P = .016). The baseline characteristics and initial laboratory findings of the 2 groups are summarized in Table 1. The admission level of fibrinogen and FAR in the SS-high group was significantly higher than that in the

Discussion

The present study demonstrated that SS was significantly associated and correlated with FAR. Our study also showed that serum fibrinogen levels are independent predictors for SS that is a scoring system used to determine the extent and severity of CAD. Moreover, we showed that an FAR of > 87 was the cutoff point for predicting a higher SS with a sensitivity of 70% and a specificity of 70% in patients with STEMI.

To our knowledge, the relationship between the FAR and SS for STEMI has not

Conclusion

The FAR is significantly related to SS in predicting the extent and severity of CAD in patients with STEMI. Moreover, the FAR provides a simple and available laboratory method for predicting severity of atherosclerosis which should be confirmed with further clinical studies in patients with STEMI and other types of CAD.

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    ☆

    Conflict interest and funding: The authors of this study declare that there is no conflict of interest regarding the publication of this manuscript. There were no external funding sources for this clinical study.

    1

    Contribution: study concept design, main researcher, and text writing.

    2

    Contribution: main researcher and text writing.

    3

    Contribution: data analysis and grouping.

    4

    Contribution: patient record and follow-up.

    5

    Contribution: data collection and analysis.

    6

    Contribution: data collection.

    7

    Contribution: drafting of manuscript.

    8

    Contribution: recording of data.

    9

    Contribution: supervisor and moderator of the study.

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