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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research 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.

Research 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 ≤ 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).

Research conclusions

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.

Research perspectives

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.