Published online Jan 26, 2023. doi: 10.4330/wjc.v15.i1.13
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
Despite the obvious progress in our management of acute coronary syndrome (ACS), it continues to be the leading cause of death worldwide with considerable short and long-term mortality and morbidity. The situation is dismal in the developing world where the health care resources are scarce. There is dire need for resource sensitive, readily available, realiable and easlity affordable biomarkers to enable appropriate resource allocation in cardiac emergencies.
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the huge deficit in health care resources worldwide and made a strong case developing efficient triaging and risk-assessment for effective patient management.
The present study aimed 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 ACS.
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.
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 ≤ 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).
Our study has shown that readily available biomarkers like fibrinogen and albumin and their ratio can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
Our study makes a strong case for the readily available and cost-effective biomarkers: Fibrinogen, albumin and their ratio (FAR) to guide appropriate clinical decision making in real world setting. It showed excellent accuracy for predictive angiographic severity and outcomes which are the most valuable piece of Information any clinician needs.