Fibrinogen is related to long-term mortality in Chinese patients with acute coronary syndrome but failed to enhance the prognostic value of the GRACE score

// Yong Peng 1,* , Tian-Li Xia 1,* , Yi-Ming Li 2 , Fang-Yang Huang 1 , Hua Chai 1 , Peng-Ju Wang 1 , Wei Liu 1 , Chen Zhang 1 , Xiao-Bo Pu 1 , Shi-Jian Chen 1 , Mao Chen 1 and De-Jia Huang 1 1 Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China 2 West China School of Medicine, Sichuan University, Chengdu, China * Drs. Yong Peng and Tian-Li Xia have contributed equally to this work Correspondence to: Mao Chen, email: // De-Jia Huang, email: // Keywords : acute coronary syndrome; fibrinogen; GRACE risk score; prognosis; Pathology Section Received : September 08, 2016 Accepted : January 24, 2017 Published : February 04, 2017 Abstract Fibrinogen (Fib) is considered to be a potential risk factor for the prognosis of patients with acute coronary syndrome (ACS), but it is unclear whether Fib level have synergistic effects to enhance the prognostic value of the GRACE score in patients with ACS. A retrospective analysis was conducted from a single registered database. 2253 consecutive patients with ACS confirmed by coronary angiography were enrolled and were grouped into 3 categories by the tertiles of admission plasma Fib levels. The end points were all-cause mortality and cardiac mortality. The mean follow-up time was 27.2 ± 13.1 months and death events occurred in 223 cases and cardiac death events occurred in 130 cases. Cumulative survival curves indicated that the risk of all-cause death increased with increasing Fib level (mortality rates for Tertile 1 vs. Tertile 2 vs. Tertile 3 = 6.6% vs. 10.8 %vs. 12.3%, p < 0.001). Cox multivariate regression analysis indicated that compared with other traditional risk factors, plasma Fib level is independently correlated with all-cause death (HR 1.33, 95% CI 1.04-1.70). However, incorporating elevated Fib level into the GRACE model did not significantly increase the predictive value of the GRACE score; for instance, AUC only increased from 0.703 to 0.713 ( p = 0.765). In conclusion, Fib level at admission was independently associated with death risk among Chinese patients with ACS. However, the incorporation of Fib level at admission into the GRACE score did not improve this score’s predictive value for death risk among these patients.