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The fibrinogen-to-albumin ratio (FAR) is an independent predictor of coronary artery disease severity and long-term major adverse cardiovascular events in patients with non-ST elevation acute coronary syndrome undergoing initial drug-eluting stent implantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2020Open Access

Relation of Fibrinogen‐to‐Albumin Ratio to Severity of Coronary Artery Disease and Long‐Term Prognosis in Patients with Non‐ST Elevation Acute Coronary Syndrome

MLMingkang LiJiangxi University of Traditional Chinese Medicine CTChengchun TangZhongda Hospital Southeast University ELErfei LuoCastle Hill Hospital

Structured PICO

Does the fibrinogen-to-albumin ratio predict the severity of coronary artery disease and long-term prognosis in NSTE-ACS patients undergoing first DES implantation?

Population

1138 consecutive non-ST elevation acute coronary syndrome (NSTE-ACS) patients firstly implanted with drug-eluting stent (DES)

Intervention

Fibrinogen-to-albumin ratio (FAR) levels (tertiles: ≤8.715%, 8.715%~10.481%, >10.481%)

Comparator

Lower FAR tertiles

Outcome

Severity of CAD (evaluated using Gensini Score) and major adverse cardiovascular events (MACE), including all-cause mortality, myocardial reinfarction, and target vessel revascularization (TVR) at 30 days, 6 months, and 1 yearcomposite

The fibrinogen-to-albumin ratio is an independent predictor of coronary artery disease severity and 1-year major adverse cardiovascular events in NSTE-ACS patients undergoing their first DES implantation.

Abstract

Previous studies showed that fibrinogen‐to‐albumin ratio (FAR) regarded as a novel inflammatory and thrombotic biomarker was the risk factor for coronary artery disease (CAD). In this study, we sought to evaluate the relationship between FAR and severity of CAD, long‐term prognosis in non‐ST elevation acute coronary syndrome (NSTE‐ACS) patients firstly implanted with drug‐eluting stent (DES). A total of 1138 consecutive NSTE‐ACS patients firstly implanted with DES from January 2017 to December 2018 were recruited in this study. Patients were divided into tertiles according to FAR levels (Group 1: ≤8.715%; Group 2: 8.715%~10.481%; and Group 3: >10.481%). The severity of CAD was evaluated using the Gensini Score (GS). The endpoints were major adverse cardiovascular events (MACE), including all‐cause mortality, myocardial reinfarction, and target vessel revascularization (TVR). Positive correlation was detected by Spearman’s rank correlation coefficient analysis between FAR and GS ( r = 0.170, P < 0.001). On multivariate logistic analysis, FAR was an independent predictor of severe CAD (OR: 1.060; 95% CI: 1.005~1.118; P < 0.05). Multivariate Cox regression analysis indicated that FAR was an independent prognostic factor for MACE at 30 days, 6 months, and 1 year after DES implantation (HR: 1.095; 95% CI: 1.011~1.186; P = 0.025. HR: 1.076; 95% CI: 1.009~1.147; P = 0.026. HR: 1.080; 95% CI: 1.022~1.141; P = 0.006). Furthermore, adding FAR to the model of established risk factors, the C‐statistic increased from 0.706 to 0.720, 0.650 to 0.668, and 0.611 to 0.632, respectively. And the models had incremental prognostic value for MACE, especially for 1‐year MACE (NRI: 13.6% improvement, P = 0.044; IDI: 0.6% improvement, P = 0.042). In conclusion, FAR was associated independently with the severity of CAD and prognosis, helping to improve risk stratification in NSTE‐ACS patients firstly implanted with DES.

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