Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jan 26, 2023; 15(1): 13-22
Published online Jan 26, 2023. doi: 10.4330/wjc.v15.i1.13
Role of fibrinogen, albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome
Kunaal Makkar, Yash Paul Sharma, Akash Batta, Juniali Hatwal, Prashant Kumar Panda
Kunaal Makkar, Yash Paul Sharma, Prashant Kumar Panda, Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Juniali Hatwal, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Author contributions: Batta A, Makkar K and Sharma YP contributed conception and design; Batta A, Makkar K, Sharma YP, Panda PK and Hatwal J contributed analysis and interpretation; Batta A contributed data collection; Batta A and Makkar K contributed writing the article; Batta A, Makkar K and Sharma YP contributed critical revision of the article; Batta A and Sharma YP contributed final approval of the article; Makkar K, Panda PK and Hatwal J contributed statistical analysis; Batta A, Makkar K and Sharma YP contributed overall responsibility.
Institutional review board statement: The protocol was approved by the institution Ethics Committee [Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh-160012, INDIA. Reference number: INT/IEC/2019/2750]
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All participants gave their written informed consent for enrollment in the study. The dataset and statistical code will be made available to the readership of the journal upon reasonable request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akash Batta, Doctor, FACC, MBBS, MD, Assistant Professor, Department of Cardiology, Dayanand Medical College and Hospital, Civil Lines, Tagore Nagar, Ludhiana 141001, Punjab, India. akashbatta02@gmail.com
Received: October 18, 2022
Peer-review started: October 18, 2022
First decision: November 2, 2022
Revised: November 8, 2022
Accepted: December 23, 2022
Article in press: December 23, 2022
Published online: January 26, 2023
Processing time: 85 Days and 11 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.

AIM

To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).

METHODS

In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.

RESULTS

Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).

CONCLUSION

Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.

Keywords: Acute coronary syndrome; Albumin; Fibrinogen; Fibrinogen to albumin ratio; Total occlusion of culprit artery

Core Tip: The study highlights the role of cost-effective, readily available biomarkers fibrinogen and albumin in predicting angiographic severity and clinical outcomes in patients with acute coronary syndrome. Fibrinogen to albumin ratio independently predicted outcomes with greater accuracy compared to fibrinogen or albumin alone. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % to predict ≤ thrombolysis in myocardial infarction 1 flow in culprit artery in ST elevation myocardial infarction (STEMI) patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity.