Association of Admission Fibrinogen-toSection Albumin Ratio with Angiographic Severity of Coronary Artery Disease in Patients with ST-Segment Elevation Myocardial Infarction: A Cross-sectional Study

Introduction: ST-Segment Elevation Myocardial Infarction (STEMI) involves intense thrombotic and inflammatory activation. Fibrinogen rises during coagulation and acutephase responses, whereas albumin may decrease during inflammation; the Fibrinogen-to-Albumin Ratio (FAR) integrates these pathways and may reflect coronary atherosclerotic burden. Evidence relating FAR to angiographic severity in STEMI remains inconsistent. Aim: To assess the association between admission FAR and Coronary Artery Disease (CAD) severity quantified by the Gensini score. Materials and Methods: This hospital-based cross-sectional study included 87 consecutive adults with confirmed STEMI at a tertiary care teaching hospital in Puducherry, India, during August 2024 to January 2026. Admission fibrinogen and albumin were measured before coronary angiography. CAD was classified by Gensini score as mild (1-19), moderate (20- 79), or severe (≥80). Spearman correlation, Kruskal-Wallis with Dunn-Bonferroni comparisons, ordinal logistic regression, and Receiver Operating Characteristic (ROC) analysis were used. Results: Mean age was 58.34±12.91 years and 61 (70.1%) participants were male. Mean FAR was 95.33±31.46 mg/g and mean Gensini score was 50.28±37.06. FAR correlated strongly with Gensini score (ρ=0.903; p-value <0.001) and increased from mild to severe CAD (71.56±10.09, 99.86±11.03, and 143.85±16.44 mg/g; p-value <0.001). FAR remained independently associated with higher CAD severity (adjusted OR 1.331; 95% CI 1.208-1.466; p-value <0.001). ROC AUC for severe CAD was 0.996; a FAR cut-off of 124.0 mg/g yielded 95.0% sensitivity and 98.5% specificity. Conclusion: Higher admission FAR was strongly associated with greater angiographic CAD severity in this single-centre STEMI cohort. External validation is required before clinical cutoffs are adopted.