Fibrinogen-to-albumin ratio and long-term mortality in oldest-old patients undergoing percutaneous coronary intervention

BACKGROUND: The fibrinogen-to-albumin ratio (FAR), a novel inflammatory marker, has demonstrated prognostic utility in cardiovascular diseases. However, its role in risk stratification among oldest-old patients (≥ 80 years) undergoing percutaneous coronary intervention (PCI) remains poorly established. METHODS: This single-center retrospective cohort study enrolled 641 consecutive patients aged ≥ 80 years with coronary artery disease who underwent PCI between 2015 and 2021. Based on the median FAR value (0.079), patients were divided into higher FAR and lower FAR groups. The endpoints were cardiovascular and all-cause mortality. Multivariable Cox models and restricted cubic splines assessed the associations between FAR and endpoints. RESULTS: During a median follow-up of 61 months, 237 deaths (37%) were recorded, of which, 124 (19.3%) were due to cardiovascular disease. The 1-year mortality was 9.3% and 5-year mortality was 27.4%. Kaplan-Meier analysis demonstrated higher FAR levels were significantly associated with increased risk of both cardiovascular and all-cause mortality (log-rank p < 0.001). According to the restricted cubic spline, the association between FAR and mortality was J-shaped. Higher FAR (> 0.079) independently predicted cardiovascular mortality (adjusted HR = 1.49, 95% CI:1.01-2.19, p = 0.045). When tested as a continuous variable, higher FAR levels were associated with a higher risk of cardiovascular (HR = 1.23, 95% CI: 1.04-1.47, p = 0.018) and all-cause mortality (HR = 1.12, 95%CI: 0.98-1.27, p = 0.090) in fully adjusted models. Subgroup analysis revealed that the association between higher FAR levels and increased cardiovascular mortality was significantly stronger in patients with triple-vessel disease (interaction p = 0.039). The associations between FAR and cardiovascular mortality remained robust in the Fine and Gray competing models (HR = 1.31, 95%CI: 1.13-1.52, p = 0.003). CONCLUSION: Higher FAR levels are associated with increased risks of cardiovascular and all-cause mortality in oldest-old patients undergoing PCI. These findings support the potential of FAR for risk stratification in geriatric cardiology.