Prognostic Value of Fibrinogen-to-Albumin Ratio in Coronary Three-Vessel Disease

Abstract

Objective

To investigate the prognostic value of fibrinogen-to-albumin ratio (FAR) in the adverse outcomes of patients with coronary three-vessel disease (TVD).

Methods

A total of 4061 patients with TVD between 2013 and 2018 were analyzed in this retrospective cohort study. The best cut‑off value of the FAR determined by receiver operating characteristic (ROC) curve analysis was 0.084. 2782 (68.5%) patients were in the low FAR group (FAR < 0.084) and 1279 (31.5%) patients were in the high FAR group (FAR ≥ 0.084), respectively. Three multivariate Cox proportional hazards models were applied to determine the associations of FAR with clinical outcomes. The concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to assess the incremental predictive value of the FAR and baseline models with respect to the additive effects of the established traditional risk factors on the discrimination of clinical outcomes. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac and cerebrovascular events (MACCEs).

Results

The median follow-up duration was 2.4 years (range 1.1–4.1 years). Multivariate Cox regression analyses showed that the incidence of all-cause mortality (4.7% vs 2.2%, adjusted hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.12–2.52, p=0.011) and MACCE (34.6% vs 27.3%, HR 1.28, 95% CI 1.13–1.46, p<0.001) were significantly higher in the high FAR group compared to the low FAR group. The C-index was 0.72 (p < 0.001), the value of NRI was 0.3778 (p < 0.001), and the value of IDI was 0.0098 (p < 0.001) for those with FAR. After FAR was added to the traditional model, the discrimination and risk reclassification ability can be significantly improved for all-cause mortality. The similar results were found for MACCE.

Conclusion

Higher level of FAR was associated with all-cause mortality and MACCE among patients with TVD. FAR could help to improve the prognostic performance of the traditional risk factors for TVD patients.

Keywords:

• three-vessel disease
• fibrinogen-to-albumin ratio
• mortality
• major adverse cardiac and cerebrovascular events
• coronary artery disease

Abbreviations

FAR, fibrinogen albumin ratio; TVD, three-vessel disease; MACCE, major adverse and cerebrovascular events; CAD, coronary artery disease; ACS, acute coronary syndrome.

Data Sharing Statement

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Acknowledgment

The authors would like to graciously acknowledgement all participants of the study and the interventional cardiologists and surgeons from the First Affiliated Hospital of Dalian Medical University for their invaluable assistance.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (82170252).