Advertisement

The relationship between fibrinogen to albumin ratio and severity of coronary artery disease in patients with STEMI

  • Author Footnotes
    1 Contribution: study concept design, main researcher, and text writing.
    Oğuz Karahan
    Correspondence
    Corresponding author at: Medical School of Dicle University, Department of Cardiovascular Surgery, 21080, Diyarbakır, Turkey. Tel.: +90 5063929320 (GSM).
    Footnotes
    1 Contribution: study concept design, main researcher, and text writing.
    Affiliations
    Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    2 Contribution: main researcher and text writing.
    Halit Acet
    Footnotes
    2 Contribution: main researcher and text writing.
    Affiliations
    Medical School of Dicle University, Department of Cardiology, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    3 Contribution: data analysis and grouping.
    Faruk Ertaş
    Footnotes
    3 Contribution: data analysis and grouping.
    Affiliations
    Medical School of Dicle University, Department of Cardiology, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    4 Contribution: patient record and follow-up.
    Orhan Tezcan
    Footnotes
    4 Contribution: patient record and follow-up.
    Affiliations
    Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    5 Contribution: data collection and analysis.
    Ahmet Çalişkan
    Footnotes
    5 Contribution: data collection and analysis.
    Affiliations
    Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    6 Contribution: data collection.
    Muhammed Demir
    Footnotes
    6 Contribution: data collection.
    Affiliations
    Medical School of Dicle University, Department of Cardiology, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    6 Contribution: data collection.
    Ahmet Ferhat Kaya
    Footnotes
    6 Contribution: data collection.
    Affiliations
    Medical School of Dicle University, Department of Cardiology, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    7 Contribution: drafting of manuscript.
    Sinan Demirtaş
    Footnotes
    7 Contribution: drafting of manuscript.
    Affiliations
    Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    8 Contribution: recording of data.
    Mehmet Uğur Çevik
    Footnotes
    8 Contribution: recording of data.
    Affiliations
    Medical School of Dicle University, Department of Neurology, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    9 Contribution: supervisor and moderator of the study.
    Celal Yavuz
    Footnotes
    9 Contribution: supervisor and moderator of the study.
    Affiliations
    Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakır, Turkey
    Search for articles by this author
  • Author Footnotes
    1 Contribution: study concept design, main researcher, and text writing.
    2 Contribution: main researcher and text writing.
    3 Contribution: data analysis and grouping.
    4 Contribution: patient record and follow-up.
    5 Contribution: data collection and analysis.
    6 Contribution: data collection.
    7 Contribution: drafting of manuscript.
    8 Contribution: recording of data.
    9 Contribution: supervisor and moderator of the study.
Published:March 03, 2016DOI:https://doi.org/10.1016/j.ajem.2016.03.003

      Abstract

      Objective

      Previous studies show that serum fibrinogen levels are established risk factors for coronary artery disease (CAD) and that serum albumin levels are of a higher specificity and sensitivity in ST-elevation myocardial infarction (STEMI). In this study, we sought to evaluate the association between fibrinogen to albumin ratio (FAR) and the extent and severity of CAD evaluated by TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries (SYNTAX) Score (SS) in patients with STEMI.

      Methods

      A total of 278 patients with STEMI were included in the study. FAR was calculated using specified variables. The extent and severity of CAD were evaluated using the SS. The patients were divided into low- (SS < 22) and high- (SS ≥ 22) risk groups. A Spearman rank correlation coefficient analysis was used for the relationship between FAR and SS. The cutoff points for sensitivity and specificity of FAR in predicting SS were estimated by performing a receiver operator characteristic curve analysis.

      Results

      There were significant differences in the mean age (P = .016), admission serum albumin (P = .041), serum fibrinogen (P < .001), FAR (P < .001), and SS risk groups. Positive correlation was detected between FAR and SS (r = 0.458, P < .001). A cutoff level of >87 FAR predicted SS (sensitivity, 70%; specificity, 70%), and an area under the curve of 0.758 serum fibrinogen and albumin level was an independent predictor for SS in patients with STEMI (b = 0.039; 95% confidence interval, 0.016-0.062; P = .001 and b = −6.906; 95% confidence interval, −12.284 to −1.527; P = .013, respectively).

      Conclusion

      In the present study, we showed that FAR is significantly related to SS in predicting the severity of CAD in patients with STEMI.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lopez A.D.
        • Mathers C.D.
        • Ezzati M.
        • Jamison D.T.
        • Murray C.J.
        Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.
        Lancet. 2006; 367: 1747-1757
        • Acet H.
        • Ertaş F.
        • Akıl M.A.
        • Polat N.
        • Aydın M.
        • Akyüz A.
        • et al.
        Novel predictor of infarct-related artery patency before percutaneous intervention and in hospital outcomes for STsegment elevation myocardial infarction patients: serum bilirubin level.
        Postep Kardiol Int. 2014; 10 ([(36)]): 91-97
        • Serruys P.W.
        • Onuma Y.
        • Garg S.
        • Sarno G.
        • van den Brand M.
        • Kappetein A.P.
        • et al.
        Assessment of the SYNTAX score in the syntax study.
        EuroIntervention. 2009; 5: 50-56
        • Wykrzykowska J.J.
        • Garg S.
        • Girasis C.
        • de Vries T.
        • Morel M.A.
        • van Es G.A.
        • et al.
        Value of the SYNTAX score for risk assessment in the all-comers population of the randomized multicenter LEADERS (Limus Eluted from A Durable versus ERodable Stent coating) trial.
        J Am Coll Cardiol. 2010; 56: 272-277
        • Girasis C.
        • Garg S.
        • Raber L.
        • Sarno G.
        • Morel M.A.
        • Garcia-Garcia H.M.
        • et al.
        SYNTAX score and clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial.
        Eur Heart J. 2011; 32: 3115-3127
        • Acet H.
        • Ertaş F.
        • Bilik M.
        • Kayan F.
        • Akıl M.A.
        • Aydın M.
        • et al.
        The relationship between neutrophil to lymphocyte ratio and SYNTAX score in patients with ST-segment elevation myocardial infarction.
        J Clin Exp Invest. 2014; 5: 211-218
        • Nelson J.J.
        • Liao D.
        • Sharrett A.
        • Folsom A.R.
        • Chambless L.E.
        • Shahar E.
        • et al.
        Serum albumin level as a predictor of incident coronary heart disease. The Atherosclerosis Risk in Communities (ARIC) study.
        Am J Epidemiol. 2000; 151: 468-477
        • Polat N.
        • Aydın M.
        • Yildiz A.
        • Acet H.
        • Akıl M.A.
        • Bilik M.Z.
        • et al.
        The prognostic significance of serum albumin in patients with acute decompensated systolic heart failure.
        Acta Cardiol. 2014; 69: 648-654
        • Gresele P.
        • Deckmyn H.
        • Huybrechts E.
        • Vermylen J.
        Serum albumin enhances the impairment of platelet aggregation with thromboxane synthase inhibition by increasing the formation of prostaglandin D2.
        Biochem Pharmacol. 1984; 33: 2083-2088
        • Mikhailidis D.P.
        • Barradas M.A.
        • Maris A.
        • Jeremy J.Y.
        • Dandona P.
        Fibrinogen mediated activation of platelet aggregation and thromboxane A2 release: pathological implications in vascular disease.
        J Clin Pathol. 1985; 38: 1166-1171
        • Joles J.A.
        • Willekes-Koolschijn N.
        • Koomans H.A.
        Hypoalbuminemia causes high blood viscosity by increasing red cell lysophosphatidylcholine.
        Kidney Int. 1997; 52: 761-770
        • Phillips A.
        • Shaper A.G.
        • Whincup P.H.
        Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes.
        Lancet. 1989; 2: 1434-1436
        • Oduncu V.
        • Erkol A.
        • Karabay C.Y.
        • Kurt M.
        • Akgün T.
        • Bulut M.
        • et al.
        The prognostic value of serum albumin levels on admission in patients with acute STsegment elevation myocardial infarction undergoing a primary percutaneous coronary intervention.
        Coron Artery Dis. 2013; 24: 88-94
        • Wilhelmsen L.
        • Svardsudd K.
        • Korsan-Bengtsen K.
        • Larsson B.
        • Welin L.
        • Tibblin G.
        Fibrinogen as risk factor for stroke and myocardial infarction.
        N Engl J Med. 1984; 311: 501-505
        • Toss H.
        • Lindahl B.
        • Siegbahn A.
        • Wallentin L.
        Prognostic influence of increased fibrinogen and C-reactive protein levels in unstable coronary artery disease.
        Circulation. 1997; 96: 4204-4210
        • Folsom A.R.
        • Wu K.K.
        • Rosamond W.D.
        • Sharrett A.R.
        • Chambless L.E.
        Prospective study of hemostatic factors and incidence of coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study.
        Circulation. 1997; 96: 1102-1108
      1. Myocardial infarction redefined: a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction.
        Eur Heart J. 2000; 21: 1502-1513
        • Sianos G.
        • Morel M.
        • Kappetein A.
        • Morice M.
        • Colombo A.
        • Dawkins K.
        • et al.
        The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease.
        EuroIntervention. 2005; 1: 219-227
        • Acet H.
        • Ertaş F.
        • Bilik M.Z.
        • Akıl M.A.
        • Özyurtlu F.
        • Aydın M.
        • et al.
        The relationship between neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and TIMI risk score in patients with STEMI before primary coronary intervention.
        Postep Kardiol Int. 2015; 11 ([(40)]): 126-135
        • Acet H.
        • Ertaş F.
        • Bilik M.Z.
        • Akıl M.A.
        • Özyurtlu F.
        • Polat N.
        • et al.
        Relationship between hematologic indices and GRACE risk score in patients with ST elevation myocardial infarction.
        Clin Appl Thromb Hemost. 2016; 22: 60-68
        • Don B.R.
        • Kaysen G.A.
        Serum albumin: relationship to inflammation and nutrition.
        Semin Dial. 2004; 17: 432-437
        • Chojkier M.
        Inhibition of albumin synthesis in chronic diseases: molecular mechanisms.
        J Clin Gastroenterol. 2005; 39: 143-146
        • Cesari M.
        • Penninx B.W.
        • Newman A.B.
        • Kritchevsky S.B.
        • Nicklas B.J.
        • Sutton-Tyrrell K.
        • et al.
        Inflammatory markers and onset of cardiovascular events: results from the health ABC study.
        Circulation. 2003; 108: 2317-2322
        • Rezkalla S.H.
        • Kloner R.A.
        Coronary no-reflow phenomenon: from the experimental laboratory to the cardiac catheterization laboratory.
        Catheter Cardiovasc Interv. 2008; 72: 950-957
        • Lapenna D.
        • Ciofani G.
        • Ucchino S.
        • Pierdomenico S.D.
        • Cuccurullo C.
        • Giamberardino M.A.
        • et al.
        Serum albumin and biomolecular oxidative damage of human atherosclerotic plaques.
        Clin Biochem. 2010; 43: 1458-1460
        • Halliwell B.
        Albumin: an important extracellular antioxidant?.
        Biochem Pharmacol. 1988; 37: 569-571
        • Libby P.
        Molecular bases of the acute coronary syndromes.
        Circulation. 1995; 91: 2844-2850
        • Kinjo K.
        • Sato H.
        • Ohnishi Y.
        • Hishida E.
        • Nakatani D.
        • Mizuno H.
        • et al.
        Osaka Acute Coronary Insufficiency Study (OACIS) Group. Impact of high-sensitivity C-reactive protein on predicting long-term mortality of acute myocardial infarction.
        Am J Cardiol. 2003; 91: 931-935
        • Hartopo A.B.
        • Gharini P.P.
        • Setianto B.Y.
        Low serum albumin levels and in-hospital adverse outcomes in acute coronary syndrome.
        Int Heart J. 2010; 51: 221-226
        • Acet H.
        • Ertaş F.
        • Aydın M.
        • Kaya H.
        • Yüksel M.
        • Bilik M.Z.
        • et al.
        The utility of the serum albumin levels on admission for predicting angiographic No reflow after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
        Abant Med J. 2015; 4: 241-249
        • Sweetnam P.M.
        • Thomas H.F.
        • Yarnell J.W.G.
        • Beswick A.D.
        • Baker I.A.
        • Elwood P.C.
        Fibrinogen viscosity and the ten year incidence of ischaemic heart disease: the Caerphilly and Speedwell studies.
        Eur Heart J. 1996; 17: 1814-1820
        • Wuillemin W.A.
        • Korte W.
        • Waser G.
        • La¨mmle B.
        Usefulness of the d-dimer/fibrinogen ratio to predict deep venous thrombosis.
        J Thromb Haemost. 2005; 3: 385-387
        • Sapmaz I.
        • Saba T.
        • Haberal C.
        • Toktamis A.
        • Cakmak M.
        • Cicek D.
        Fibrinogenalbumin ratio: an intriguing relationship for assessing thrombosis risk and suspicious effect on blood viscosity.
        Int Cardiovasc Res J. 2011; 5: 153-154
        • Takamatsu S.
        • Satoh K.
        • Osanai I.
        • Kawamura Y.
        • Mizuno S.
        • Takamatsu M.
        • et al.
        Fibrinogen/albumin ratio: a useful indicator of hemorheological abnormalities in observation of cerebrovascular disorders.
        in: Hartmann A. Hoyer S. Cerebral blood flow and metabolism measurement. Springer-Verlag, Berlin1985: 130-135
        • Karahan O.
        • Yavuz C.
        • Kankilic N.
        • Demirtas S.
        • Tezcan O.
        • Caliskan A.
        • et al.
        Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency.
        Blood Coagul Fibrinolysis. 2015; 26 ([00–00])
        • Narang R.
        • Ridout D.
        • Nonis C.
        • Kooner J.S.
        Serum calcium, phosphorus and albumin levels in relation to the angiographic severity of coronary artery disease.
        Int J Cardiol. 1997; 60: 73-79